Classifying neurogenic dysphagia as a movement disorder

Abstract

Swallowing is a complex sensorimotor task critical for maintaining nutrition, hydration and quality of life. Given the widespread neural involvement and combined volitional and reflexive control, many neurologic conditions can result in swallowing disorders (dysphagia). There is no classification framework for neurogenic dysphagia according to where dysfunction lies within the sensorimotor hierarchy. Thus, underlying neuropathology is not thoroughly considered during dysphagia assessment and rehabilitation. In this review, we explore neurogenic dysphagia through classical sensorimotor hierarchy and movement disorders terminology. We provide comprehensive evidence of dysphagia signs and symptoms in pure cases of movement disorders and discuss nuances related to assessing signs of neuropathology responsible for disordered oropharyngeal swallowing biomechanics. Appreciation of the complexities of dysphagia and investigations into underlying pathologies will advance clinical management of neurogenic dysphagia and inform investigations of dysphagia identification and treatment.

Keywords: deglutition; deglutition disorders; motor hierarchy; movement disorders.

Figure 1

Classical sensorimotor hierarchy. Connections between nodes in the pyramidal, extrapyramidal and sensorimotor systems depicted by arrows. NMJ = neuromuscular junction. Created in BioRender. Jones, C. (2025) https://BioRender.com/mge3k79.