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Tactile thermal oral stimulation increases the cortical representation of swallowing

Inga K Teismann12*, Olaf Steinsträter2, Tobias Warnecke1, Sonja Suntrup12, Erich B Ringelstein1, Christo Pantev2 and Rainer Dziewas1

Author Affiliations

1 Department of Neurology, University of Muenster, Albert-Schweitzer-Str.33, 48149 Muenster, Germany

2 Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany

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BMC Neuroscience 2009, 10:71  doi:10.1186/1471-2202-10-71

Published: 30 June 2009



Dysphagia is a leading complication in stroke patients causing aspiration pneumonia, malnutrition and increased mortality. Current strategies of swallowing therapy involve on the one hand modification of eating behaviour or swallowing technique and on the other hand facilitation of swallowing with the use of pharyngeal sensory stimulation. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Little is known about the possible mechanisms by which this interventional therapy may work. We employed whole-head MEG to study changes in cortical activation during self-paced volitional swallowing in fifteen healthy subjects with and without TTOS. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of individual SAM data was performed using a permutation test.


Compared to the normal swallowing task a significantly increased bilateral cortical activation was seen after oropharyngeal stimulation. Analysis of the chronological changes during swallowing suggests facilitation of both the oral and the pharyngeal phase of deglutition.


In the present study functional cortical changes elicited by oral sensory stimulation could be demonstrated. We suggest that these results reflect short-term cortical plasticity of sensory swallowing areas. These findings facilitate our understanding of the role of cortical reorganization in dysphagia treatment and recovery.