Motor Imagery in Post-Stroke Dysphagia

The Effect of Motor Imagery on Swallowing Functions in Patients With Post-Stroke Dysphagia: A Single-Blind Randomized Controlled Study

This study evaluated the effects of motor imagery added to conventional swallowing rehabilitation in patients with dysphagia after stroke. Dysphagia, or swallowing difficulty, is a common problem after stroke and may increase the risk of aspiration, pneumonia, malnutrition, dehydration, and reduced quality of life.

Participants with post-stroke dysphagia were randomly assigned to one of three groups: video-assisted motor imagery, motor imagery alone, or control. All participants received conventional swallowing rehabilitation. In addition, the video-assisted motor imagery group watched videos showing swallowing-related actions and then mentally imagined the observed movement. The motor imagery alone group performed mental imagery of swallowing without visual stimulation. The control group received only conventional swallowing rehabilitation.

The intervention period lasted 4 weeks, with sessions performed twice weekly. Swallowing function was assessed before and after treatment using the Gugging Swallowing Screen, the Penetration-Aspiration Scale based on videofluoroscopic swallowing study, and the Stroke Impact Scale.

The aim of the study was to determine whether motor imagery, especially when supported by video observation, provides additional benefit for swallowing recovery in patients with post-stroke dysphagia.

This single-blind randomized controlled study was conducted in patients with post-stroke oropharyngeal dysphagia receiving inpatient rehabilitation. The study aimed to evaluate whether motor imagery added to conventional dysphagia rehabilitation improves swallowing function, and whether video-assisted motor imagery provides additional benefit compared with motor imagery alone.

Participants were randomly assigned to one of three groups. The video-assisted motor imagery group received conventional dysphagia rehabilitation plus video-assisted motor imagery. In this group, patients watched videos showing swallowing-related actions and then mentally simulated the observed swallowing movement. The motor imagery alone group received conventional dysphagia rehabilitation plus motor imagery training without visual stimulation. The control group received only conventional dysphagia rehabilitation.

The intervention was administered twice weekly for 4 weeks. Swallowing function was assessed before and after treatment using clinical and instrumental outcome measures, including the Gugging Swallowing Screen and the Penetration-Aspiration Scale based on videofluoroscopic swallowing study. Stroke-related functional impact and quality of life were evaluated using the Stroke Impact Scale.

The study was designed to determine whether motor imagery is a feasible adjunctive rehabilitation approach for improving swallowing safety and swallowing-related outcomes in patients with post-stroke dysphagia.

Inclusion Criteria:

• Age 18 years or older
• Diagnosis of stroke by a neurologist based on medical history, physical examination, and brain computed tomography and/or magnetic resonance imaging findings
• No progressive or non-progressive neurological disease other than stroke
• No known psychiatric disease
• No sensory dysfunction
• No communication problem
• Mini-Mental State Examination score of 24 or higher and ability to follow commands at a level sufficient to comply with motor imagery practice
• Ability to maintain sitting balance and remain in a sitting position for 30 minutes
• Presence of dysphagia symptoms or need for further evaluation based on dysphagia screening tests, with referral for videofluoroscopic swallowing study
• No serious acute medical condition such as hemodynamic instability during testing

Exclusion Criteria:

• Refusal to participate in the study or withdrawal from the study during the study period
• Inadequate performance of videofluoroscopic swallowing evaluation due to technical, clinical, or patient compliance-related reasons
• Presence of sensory-motor aphasia
• Presence of visual or hearing impairment
• Presence of severe neglect
• Evidence of esophageal dysphagia on videofluoroscopy and/or clinical symptoms
• History of surgery, cancer, or radiotherapy in the head and neck region that may affect swallowing
• Presence of vertebral problems that may restrict cervical movement, such as advanced cervical discopathy, prominent osteophyte formation, or cervical deformity
• Presence of neurological diseases other than stroke that may cause dysphagia, such as dementia, Parkinson disease, multiple sclerosis, or neuromuscular disease