Neuromuscular-related interventions for post-stroke dysphagia: a comprehensive narrative review

To systematically review the efficacy, mechanisms, and application characteristics of neuromuscular-related interventions for post-stroke dysphagia (PSD), and to examine strategy selection across different swallowing stages to inform individualized rehabilitation strategies.

PubMed, Web of Science, Embase, and MEDLINE were systematically searched for studies published between 1995 and 2025. Titles and abstracts were screened, and the full texts of eligible studies were retrieved for further analysis. Interventions related to neural and muscular regulation were categorized and synthesized into four main groups: exercise training and behavioral interventions; peripheral neuromuscular stimulation; central nervous system modulation techniques; and other adjunctive interventions.

A total of 293 publications were included, of which 56.63% were randomized controlled trials. The interventions were summarized into four major categories comprising more than 10 techniques. Exercise training and behavioral interventions (e.g., oral motor exercises) enhanced swallowing muscle strength and coordination. Peripheral neuromuscular stimulation (e.g., neuromuscular electrical stimulation and acupuncture) enhanced or modulated swallowing function by directly stimulating relevant nerves or muscles. Central nervous system modulation techniques (e.g., transcranial magnetic stimulation and transcranial direct current stimulation) influenced swallowing-related neural networks indirectly by regulating cortical excitability. Other adjunctive interventions included botulinum toxin injection, which directly targeted the cricopharyngeal muscle. Further analysis examined the selection of key rehabilitation techniques across different clinical stages of PSD, integrating central and peripheral neuromodulation approaches. It explored the potential implications of soft-tissue surgery and meridian-muscle theory for PSD management to inform individualized clinical decision-making.

Neuromuscular interventions were found to be widely used in PSD management, particularly transcranial magnetic stimulation, acupuncture, and neuromuscular electrical stimulation. Future strategies should integrate pathology, clinical manifestations, and lesion localization to develop central lesion-oriented multimodal therapies that combine peripheral nerve and muscle interventions, potentially improving clinical outcomes.