Swallowing is controlled by a distributed neural network spanning the brainstem central pattern generator, subcortical modulatory circuits, and cortical regions responsible for volitional planning and sensorimotor integration. Evidence from lesion studies, neuroimaging, and neurophysiology demonstrates that dysphagia arises from disruptions at different nodes of this network, producing lesion-specific impairment profiles rather than a uniform swallowing deficit. This network-based perspective has shifted rehabilitation from predominantly compensatory management toward mechanism-driven interventions aimed at restoring physiological function. Behavioral skill-training and resistance-based exercises harness motor learning and cortical plasticity, whereas neuromodulatory approaches—including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), pharyngeal electrical stimulation (PES), and emerging vagus nerve stimulation (VNS)—target specific components of the swallowing system through top-down or bottom-up modulation. Despite substantial progress, key gaps persist, including limited understanding of white-matter connectivity, inconsistent lesion–symptom mapping findings, and a narrow evidence base focused primarily on stroke. Advancing dysphagia rehabilitation will require network-level conceptual frameworks, multimodal imaging, and neurophysiology-guided clinical trials to develop individualized, precision therapies grounded in the heterarchical organization of swallowing control.
Wei et al. (Thu,) studied this question.