ABSTRACT
Effective rehabilitation of dysphagia requires clear and accurate clinical diagnosis of underlying pathophysiology. Differential diagnosis, however, may be limited by our understanding of swallowing pathophysiology and the absence of instrumentation to define the underlying nature of impairment. This report outlines the clinical pathway of a patient with dysphagia after a stroke who presented with severe multi-faceted dysphagia. He was first treated with a traditional strength training approach, despite difficulty eliciting a swallowing response consistently. This approach was ineffective. After a change to skill-based training, which facilitated improved volitional initiation and control of swallowing, further instrumental assessment suggested that the underlying impairment may be due to poor motor planning and/or upper (o)esophageal (UES) non-compliance. The UES was dealt with using medical management, and the motor planning deficits through specific skill-based training focusing on pharyngeal pressure generation. This staged approach resulted in positive physiological and functional outcomes, and emphasizes the need for careful delineation of pathophysiology.
