Digital Commons Network^™

Creatine Monohydrate For Lean Mass, Strength, And Bone Density In Postmenopausal Women: A Systematic Review And Meta-Analysis, Siavash Naddafha, Jose Antonio, Richard B. Kreider, Jeffrey R. Stout

Research outputs 2022 to 2026

Background: Menopause is accompanied by accelerated losses in muscle mass and strength and declining bone density. Whether creatine monohydrate benefits postmenopausal women are uncertain. Methods: We systematically reviewed randomized, placebo-controlled trials examining creatine supplementation, with or without resistance training (RT), in postmenopausal women. MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, and Cochrane CENTRAL were searched from 2000 to August 2025, supplemented by trial registries and reference-list screening. Eligible studies included postmenopausal women aged ≥40–45 years, intervention durations ≥6 weeks for primary analyses, and outcomes including DXA-derived lean mass, one-repetition maximum (1RM) strength, bone mineral density, physical function, and safety. Dual …

Startle Habituation And Vagally Mediated Heart Rate Variability Influence The Use Of Emotion Regulation Strategies, Xiao Yang, Fang Fang, Angela Ximena Babb

Psychology Faculty Publications

Emotion regulation refers to the processes through which people modulate their emotional experiences and expressions, and difficulties in these processes underpin many forms of psychopathology. According to the process model, emotion regulation encompasses five classes of strategies, commonly grouped into antecedent-focused strategies (e.g., cognitive reappraisal) and response-focused strategies (e.g., expressive suppression). These strategies involve both explicit and implicit processes, which can be objectively assessed using physiological indices. The present study examined the effects of startle habituation and vagally mediated heart rate variability (vmHRV) on the use of cognitive appraisal and suppression. Forty-nine college-aged participants were recruited, and their resting heart …

Diagnosing The Discourse: How The Academy Of Breastfeeding Medicine Constructs And Constrains Treatment Of Tethered Oral Tissues, Mary E. Miller

Antioch University Dissertations & Theses

While breastfeeding is recognized as fundamental to global public health, oral restrictions that can affect infant latch, milk transfer, and feeding efficiency warrant further examination within policy frameworks. This dissertation proposes an expanded conceptualization of tethered oral tissues (TOTs) that encompasses not only anatomical frenal restrictions but also fascial tensions, neuromuscular limitations, and other conditions restricting orofacial function that may be congenital or acquired. The purpose of this study was to critically examine how this clinical guidance document shapes understandings and responses to TOTs. Using Carol Bacchi’s “What’s the Problem Represented to Be?” approach, a critical discourse analysis of the …

Bridging Worlds Of Care: A Qualitative Exploration Of Integrating Non-Western Healing Modalities With Mental Health Counseling, Douglas Valdez

Antioch University Dissertations & Theses

The aim of the study is to explore the experiences of practitioners who treat individuals presenting with depression and anxiety using culturally integrative non-Western healing modalities. Participants included 15 experienced practitioners (minimum five years of practice) who identified as Traditional Chinese Medicine providers (e.g., acupuncturists, herbalists) and/or Curandero/x/as. The approach was qualitative, utilizing open-ended survey responses collected electronically and analyzed with thematic analysis. Results indicated six primary themes: (a) Philosophies in Healing, highlighting culturally grounded conceptualizations of depression and anxiety; (b) Traditional Chinese Medicine Interventions, including acupuncture, botanical, nutritional, manual, and movement-based practices; (c) Curanderismo Pláticas and Integrative Western Healing …

The Lived Experience Of Tenders Of Community Grief Rituals, Margaret Y. Wilson

Antioch University Dissertations & Theses

The purpose of this research study is to gain an understanding of the lived experience of tenders of community grief rituals, and how tenders make meaning of their experiences. This study utilized photo elicitation and a reflexive thematic analysis. Participants (N = 11) provided one to three photographs that captured their experience of grief and/or tending grief rituals. The results identified 10 themes supported by subthemes: (a) Grief Tender Wisdom About the Nature of Grief, (b) Life’s Many Experiences are Sources of Grief, (c) The Multifaceted Impacts of Grief-Body, Anger, Compassion, Empathy, Resilience, Gratitude, Joy, and Love, (d) The Nuances …

How To Reduce Inpatient Violence: A Theory Synthesis From Four Models, Arthur Walker

Antioch University Dissertations & Theses

Working in an inpatient setting inherently involves an increased risk of violence. This violence can affect both staff and patients alike and can lead to psychological trauma, serious bodily injury, and even death. To mitigate this risk, many models for preventing inpatient violence have been proposed for hospitals to implement. However, the evidence for the efficacy of these methods is inconsistent, and the theoretical underpinnings are varied and slim. This dissertation seeks to improve these models by re-examining the theoretical structures for common themes of four models for inpatient violence reduction and proposing additional recommendations informed by this synthesis. First, …

Beyond The Rabbit Hole: Dmt, Death, And The Hereafter, Abby Molina

Antioch University Dissertations & Theses

This dissertation explores a proposed relationship between death and N,N-dimethyltryptamine (DMT) within the context of contemporary clinical psychology and the current psychedelic renaissance. Building on Rick Strassman’s hypothesis that DMT may be released at the moment of death and Imants Barušs’ conceptualization of death as an altered state of consciousness, this project examines the phenomenological similarities between DMT-induced experiences (psychedelic “trips”) and near-death experiences (NDEs). Through review of neurobiological research, psychedelic-assisted therapy literature, religious and cultural ceremonial practices, and documented DMT trip and NDE reports, this work evaluates the plausibility that endogenous DMT contributes to altered states of consciousness observed …

Periodontitis During Pregnancy: The Effect On The Gut Microbiome And Intestinal Inflammation, Richard Bright, G. Macowan, Keyuan Tian, Tracy Fitzsimmons, Rebecca L. Wilson, Claire T. Roberts, Claus T. Christophersen, Peter M. Bartold, Stephen P. Kidd, Peter S. Zilm

Research outputs 2022 to 2026

Background: Periodontitis has been epidemiologically associated with adverse pregnancy outcomes, but causality remains difficult to establish in humans due to confounding factors. This study uses a controlled murine model to examine the effects of experimentally induced periodontitis on the composition of the gut microbiota and gastrointestinal inflammation during pregnancy. Methods: Periodontitis was induced in pregnant BALB/c mice via oral inoculation with Porphyromonas gingivalis and Fusobacterium nucleatum before conception (n = 20 per group). Pregnancy outcomes, gut histology, systemic inflammatory markers, and microbiome composition, assessed by 16S rRNA sequencing, were evaluated at gestational Day 18. Results: Periodontitis was confirmed by significant …

Ornithine Metabolism In Retinal Pigment Epithelium And Retina And Implications In Gyrate Atrophy, Artjola Puja

Graduate Theses, Dissertations, and Problem Reports (ETD)

Ornithine aminotransferase (OAT) is a mitochondrial enzyme that regulates ornithine metabolism by converting ornithine to pyrroline-5-carboxylate, a precursor for proline and glutamate synthesis. Deficiency of OAT causes systemic ornithine accumulation and leads to gyrate atrophy (GA) of the choroid and retina, a hereditary disorder characterized by progressive chorioretinal degeneration and irreversible vision loss. Chorioretinal atrophy typically starts at the mid-peripheral retina and progresses toward the macula. Although elevated ornithine is considered toxic to the eye, how ornithine is metabolized in ocular tissues and why OAT deficiency causes selective, region-specific vulnerability remain unclear. We combined ex vivo and in vivo stable …

Sglt2 Inhibitors In Cardio-Oncology: A Systematic Review And Meta-Analysis, Luigi Spadafora, Marco Bernardi, Gianmarco Sarto, Beatrice Simeone, Erica Rocco, Salvatore Carbone, Laura Adelaide Dalla Vecchia, Roberto Franco Enrico Pedretti, Valentina Valentine, Rachele Di Mario, Maurizio Forte, Giacomo Frati, Antonio Abbate, Michele Golino, Francesco Versaci, Mariangela Peruzzi, Pierre Sabouret, Giuseppe Biondi Zoccai, Sebastiano Sciarretta

EVMS School of Health Professions Faculty Publications

Background

According to available evidence, sodium-glucose cotransporter-2 inhibitors (SGLT2i) may confer cardioprotection in patients with cancer undergoing chemotherapy.

Objectives

The objective of the study was to evaluate the impact of SGLT2i on all-cause mortality and heart failure (HF) outcomes in this population.

Methods

We searched PubMed, Cochrane CENTRAL, and Embase through August 2025 for studies of SGLT2i in adult patients with cancer. Random-effects models were used to pool effects for all-cause mortality and an HF composite (new-onset HF and/or HF hospitalization) in cancer patients >18 years. Meta-regression tested effect modification by beta-blockers, statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, age, and …

Proof-Of-Concept Development And Preclinical Evaluation Of A Microarray Patch Platform For Codelivery Of Multiple Broadly Neutralizing Antibodies For Hiv Prevention, M. Melissa Peet, Vivek Agrahari, Parbeen Singh, Lam Luong Hoai Nguyen, Louise A. Ouattara, Eun Sung Yang, Carolina Herrera, Amarendra Pegu, Theodore C. Pierson, Thanh D. Nguyen, Gustavo F. Doncel

CONRAD Publications

Broadly neutralizing antibodies (bnAbs) are advancing as a preventative or treatment option for HIV infection, but currently must be administered parenterally, typically as a large injection or infusion, an invasive method of delivery, especially for the pediatric population. Here, we present proof-of-concept data on a minimally invasive microneedle (MN) patch platform codelivering three bnAbs, PGT121, VRC07-523LS, and PGDM1400LS, from separate MN patch units or pixels. Each 1 cm² patch pixel, fabricated via solvent casting, contained ∼2 mg of one bnAb. In ex vivo porcine skin tests, the MNs effectively penetrated the skin. When tested in vitro in PBS buffer, MNs …

Proof-Of-Concept Development And Preclinical Evaluation Of A Microarray Patch Platform For Codelivery Of Multiple Broadly Neutralizing Antibodies For Hiv Prevention, M. Melissa Peet, Vivek Agrahari, Parbeen Singh, Lam Luong Hoai Nguyen, Louise A. Ouattara, Eun Sung Yang, Carolina Herrera, Amarendra Pegu, Theodore C. Pierson, Thanh D. Nguyen, Gustavo F. Doncel

CONRAD Publications

Broadly neutralizing antibodies (bnAbs) are advancing as a preventative or treatment option for HIV infection, but currently must be administered parenterally, typically as a large injection or infusion, an invasive method of delivery, especially for the pediatric population. Here, we present proof-of-concept data on a minimally invasive microneedle (MN) patch platform codelivering three bnAbs, PGT121, VRC07-523LS, and PGDM1400LS, from separate MN patch units or pixels. Each 1 cm² patch pixel, fabricated via solvent casting, contained similar to 2 mg of one bnAb. In ex vivo porcine skin tests, the MNs effectively penetrated the skin. When tested in vitro in PBS …

Comparison Of Push-Pull Air Curtain To Overhead Downdraft Systems On Aerosol Containment And Distribution In Controlled Environments, Manal Mutairi

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Comparison of Push-Pull Air Curtain to Overhead Downdraft Systems on Aerosol Containment and Distribution in Controlled Environments.

This dissertation looks at the ongoing issue of tiny airborne particles created during medical and dental procedures and evaluates ways to reduce the risk of exposure for healthcare workers and patients to these particles. The first study focuses on the size, how long particles stay in the air, and how far they travel from common medical procedures that create aerosols, showing that tiny particles (less than 5 µm) can stay in the air long enough to escape basic droplet controls. As a …

Increasing Documentation Of Endotracheal Tube Cuff Pressures: A Quality Improvement Initiative For Flight Crew Providers, Matthew D. Noss

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: There was a lack of documentation of endotracheal tube (ETT) cuff pressures (CPs) by flight crew providers at Base 1 of HealthNet Aeromedical Services. A three-month pre-intervention data collection showed 1.8% of patients had initial CPs documented. Inadequate documentation and monitoring of ETT CPs can lead to patient complications such as tracheal injury and aspiration making this an important area for quality improvement.

Purpose: To increase documentation of ETT CPs through education and evidence-based interventions.

Intervention: This project implemented an educational in-service on ETT cuff syringe manometry for flight crew providers. The educational intervention consisted of …

Video-Based Heart Failure Education: A Feasibility Study, Avery Pivont

Graduate Theses, Dissertations, and Problem Reports (ETD)

Video-Based Heart Failure Education: A Feasibility Study

Avery Pivont

Background:  Heart failure (HF) is a leading cause of hospitalization in the U.S., contributing to high readmission rates and significant healthcare costs. Many of these readmissions are preventable and often stem from inadequate patient education. Effective patient education is a critical component of HF management; however, many healthcare facilities lack specialized HF nurse educators, resulting in inconsistent patient education.

Problem Statement: A quality improvement team at a large academic hospital identified increased heart failure (HF) readmission rates across an entire health system, largely attributed to inconsistent discharge education and limited availability …

Electronic Cigarettes Increase Blood-Brain And Blood-Tumor Barrier Drug Efflux In A Preclinical Lung Cancer Model Of Brain Metastasis, Cullen Parker Wolford

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation (a) provided a comprehensive review of the known therapeutic challenges in nicotine delivery system users with lung cancer and (b) investigated the impact of electronic cigarettes on blood-brain/blood-tumor barrier function and efficacy of small molecule KRAS inhibitors in a syngeneic lung cancer brain metastasis model. The blood-brain barrier is a physiochemical barrier that limits systemic delivery of therapeutics into brain. When tumors invade the central nervous system, the blood-brain barrier is disrupted and subsequently forms a blood-tumor barrier. Despite the inherent leakiness and variable permeability of the blood-tumor barrier, it continues to restrict anti-cancer drugs from accumulating at …

Effects Of An Early-Onset Hfd On Hepatic Functioning In A 3xtg Model Of Ad, Matthias Hirst

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Approximately 1 billion people currently live with obesity. Driven by factors such as a high-fat diet (HFD), this pathology can have drastic effects throughout the body, with the liver in particular being a main target of its downstream consequences. Although it is capable of storing lipids, excess fat can conglomerate in the liver and contribute to various hepatic pathologies. A specific pattern of hepatic dysfunction seen in response to an HFD is increased acetylation of mitochondrial proteins. Further, expression and activity of insulin-degrading enzyme (IDE), involved in the degradation of Aβ, are altered in response to an HFD. Aβ …

Accessing Campus Mental Health Services In A Nigerian Southwestern University: Barriers To Academic Success, Caroline Dada

Electronic Theses and Dissertations

Mental health disorders are a significant health concern among higher education institutions in sub-Saharan Africa, including Nigeria. A substantial treatment gap exists in the Nigerian healthcare system, and this gap is further worsened by cultural and religious barriers, which reinforce stigma that discourages students from seeking professional help. This qualitative narrative inquiry explored the barriers students encountered when accessing mental health services at a university in Southwestern Nigeria, to increase service access. Qualitative semistructured interviews were conducted with seven professional mental health providers at a university counseling center between March and April 2025. Inductive thematic analysis was used to identify …

Study Of The Relationship Between Insulin Resistance And Osteoporosis In Type 2 Diabetes Mellitus And Diabetic Nephropathy Elderly Patients, Mohamed Zakarya Nooh, Alaa Abdelsalam Dawood, Bassant Samy Hamed Hafez, Moustafa Bakrey Hamed Ata

Mansoura Medical Journal

Background Type 2 diabetes mellitus and diabetic kidney disease play a major role in bone deterioration and increased fracture risk because they influence both insulin sensitivity and bone metabolism. Objective The purpose of this study was to investigate the connection between osteoporosis and insulin resistance in older individuals with type 2 diabetes and diabetic kidney disease (DKD). Methods: A total of 105 participants were enrolled in the study and divided equally into three groups: 35 diabetic patients with albuminuria, 35 diabetic patients without albuminuria, and 35 age- and gender-matched healthy controls. The study was conducted at the Endocrinology & DM …

Chronic Stress And Toxoplasma Gondii Infection: Investigating The Two-Hit Hypothesis On Behavior And Cognition In Chronic Toxoplasmosis Mice Model, Nora Labeeb El-Tantawy

Mansoura Medical Journal

Background: Toxoplasmagondii infects about one third of people around the world and is associated with neuropsychiatric disorders. But not everyone who has it ends up with behavioral symptoms, which is kind of interesting. The study aimed to investigate the two-hit hypothesis, basically testing if chronic stress makes the effects of the infection worse in mice, on behavior and cognition. Methods: Sixty Swiss Webster mice were included in the study divided into four groups (15 for each). Group 1 control, group 2 stressed animals exposed to the chronic unpredictable stress protocol, Group 3 infected with T. gondii, and group 4 received …

The Role Of Vitamin D In Management Of Pediatric Chronic Immune Thrombocytopenia, Eman Magdy Yahia, Suzy Abd El Mabood Abd El Hameed, Dalia Tawfeek Hussein, Amany Mamdouh Shoumah

Mansoura Medical Journal

In children, immune thrombocytopenia (ITP) remains a serious health concern, which is an autoimmune disorder (AID) characterized by an isolated decrease in platelet count, leading to an increased risk of bleeding.

The use of vitamin D supplementation represents a turning point in many autoimmune diseases, with the potential to deliver high cure rates with fewer side effects than previous therapies. In this review, we explore the incidence of ITP , immunopathogenesis, diagnosis and management in pediatric patients. We will discuss the mechanisms of action of vitamin D , focusing on its role in autoimmune diseases especially ITP

Demographic Characteristics In Patients With Heart Failure And Iron Deficiency, Ahmed Alaa Eldin Abd Elazeem, Abdul Razek Abdul Lateef Maaty, Hanan Ahmed Azzam, Ahmed Mohamed Reda

Mansoura Medical Journal

Background: Iron deficiency (ID) is a major and prevalent comorbidity among heart failure (HF) patients. It is associated with poor exercise tolerance, recurrent hospitalization and higher mortality. Studying patients’ demographics helps to determine vulnerable groups to ID, risk factors and associated comorbidities to be considered during screening and management.

Aim of the Work: To study the demographic characteristics of heart failure patients with iron deficiency.

Patients and Methods: A cross sectional observational study was conducted at a tertiary care university hospital at Delta region of Egypt between year 2024 and 2026. Among 117 HF patients, 100 HF patients …

The Potential Role Of Naftidrofuryl Oxalate In Rat Model Of Ulcerative Colitis, Omar Mohsen Elmazny, Ahmed Abdel-Monem Elmetwally, Vivian Boshra, H.M. El-Beltagi, Basma Hamed Othman, Heba Sheta

Mansoura Medical Journal

Background: Ulcerative colitis (UC) is a chronic, recurrent bowel disease characterized by inflammation that leads to superficial damage to the colon wall. The rate of incidence of UC differs from 0.5 to 31.5 per 100,000 subjects annually. The exact cause is still not well-identified. Studies suggest genetic factors, altered immune response, and environmental factors may play a role in the initiation and progression of the disease. Its pharmacological treatment remains unsatisfactory. Aim: To assess the possible protective effect of Naftidrofuryl oxalate (NFT) (praxilene) on intestinal epithelial cells in acetic acid (AA)-induced UC model in rats.  Materials and Methods: sixty female …

Diagnostic Accuracy Of Combined B-Mode Ultrasound, Color Doppler And Strain Elastography In Assessment Of Cervical And Axillary Lymph Nodes, Marwa Mostafa, Nihal M. Batouty, Amani Ezzat Mousa

Mansoura Medical Journal

Background: Lymphadenopathy is a common condition caused by many benign and malignant disorders; therefore, determining their nature is important in clinical setting. The objective of research is to assess diagnostic accuracy of B-mode ultrasound, color Doppler, and strain elastography in lymph nodes evaluation with pathological correlation and to determine cut-off value of strain ratio that differentiates benign from malignant nodes.

Methods: All patients underwent ultrasound examination, Doppler study and strain elastography in supine position using a high-frequency probe (6.2-12 MHz). Out of 80 enrolled patients, only 53 were subjected to biopsy from the lymph nodes, then their pathological results …

Active Deresuscitation Strategies After Septic Shock: A Scoping Review, Alrefaey K. Alrefaey, Rania E Elbadrawy, Mohamed Aboelela, Mohammed Mamoun

Mansoura Medical Journal

Background: Fluid overload in septic shock patients is linked to higher morbidity and mortality. After the stabilization phase, fluid restriction may not result in the resolution of tissue edema. Active deresuscitation refers to the use of diuretics or ultrafiltration for the removal of excess fluids. Objectives: This review explores the current practices applied for the active deresuscitation strategies after stabilization of septic shock patients.  Search strategy: A literature search was performed through the following databases: Medline, PubMed, Google Scholar, Web of Science, and Scopus for relevant studies from 2015 to January 2026. Selection criteria:  The selected articles included …

Study Of Serum Zinc And Copper Levels In Type 2 Diabetic Patients With And Without Nephropathy, Hayam Elmetwally, Ahmed Almenshawy, Alaa Sabry, Rania Bahriz

Mansoura Medical Journal

Background: Diabetic Nephropathy (DN) is one of the most important microvascular complications of Diabetes mellitus (DM). The purpose of this study was to look at how changes in serum zinc and copper levels relate to the incidence of diabetic nephropathy in individuals with type 2 diabetes.

Methods: The type of the study is an observational case-control study. This observational case control study was conducted over a period of one year and included 90 adult subjects. Subjects were categorized into three equal parties. Patients without nephropathy who had type 2 diabetes were included in Group I (n=30) . Patients …

Engineering Plga Nanoparticle Size To Modulate Immune Responses After Spinal Cord Injury, Daniel J. Kolpek

University of Kentucky Doctoral Dissertations

Spinal cord injury is a severe and debilitating condition that often results in lifelong complications, including paralysis. Many of these chronic outcomes are driven by a sustained inflammatory response at the injury site, which limits tissue regeneration and functional recovery. As a result, therapeutic strategies that modulate this immune response have gained significant interest. Polymer based nanoparticle therapies have emerged as a promising approach due to their ability to interact with and influence immune cell behavior. Importantly, the physicochemical properties of nanoparticles can be precisely tuned to optimize these effects. Among these properties, size has been shown to influence key …

Senescent Fibroblasts In Aging And Pulmonary Fibrosis, Sara B. Palega, Aiwei Y. Borengasser, Yan Y. Sanders

Department of Biomedical and Translational Sciences Faculty Publications

Aging is a major risk factor for many chronic lung diseases, including Idiopathic Pulmonary Fibrosis (IPF), a fatal and incurable disease characterized by progressive fibrotic remodeling. Age-associated structural alterations, impaired regenerative capacity, and dysregulated cellular signaling collectively create a pro-fibrotic microenvironment. A central driver of this pathological shift is the accumulation of senescent cells, which undergo irreversible growth arrest and develop a robust pro-inflammatory senescence-associated secretory phenotype (SASP). Emerging evidence identifies senescent lung fibroblasts as critical mediators of IPF pathogenesis. These cells promote excessive extracellular matrix deposition, myofibroblast differentiation, and tissue stiffening, while simultaneously impairing epithelial regeneration. Together, these effects …

Stim1-Dependent Treg Dysfunction Promotes Cardiometabolic Hfpef: Insights From Patients And Animal Studies, Balaji Srinivas, Alluri Kiran, Hongmei Peng, Jiang Xu, Paula Fortuno, Jennifer May, Ismail El Moudden, Nour-Eddine Rhaleb, John M. Herre, Raymond L. Benza, Khalid Matrougui

Department of Biomedical and Translational Sciences Faculty Publications

Background

Heart failure with preserved ejection fraction (HFpEF) arises from chronic cardiometabolic and vascular stress and is increasingly recognized as an inflammatory syndrome with immune dysregulation. Regulatory T cells (Tregs) are critical modulators of cardiovascular inflammation, yet the mechanisms driving Treg dysfunction in HFpEF remain poorly defined. stromal interaction molecule 1 (STIM1)-dependent calcium signaling is a key stress-responsive pathway in immune cells; however, its role in Treg maladaptation during HFpEF remains unknown.

Methods

Circulating Tregs from patients with and without HFpEF were analyzed for abundance, STIM1 expression, and stress-associated signaling pathways. To establish causality, mice with Treg-specific deletion of STIM1 …

A Narrative Review Of The Central Neural Control Of Swallowing And Its Implications For Dysphagia Rehabilitation, Kuo-Chang Wei, Tyng-Guey Wang, Ming-Yen Hsiao

Rehabilitation Practice and Science

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 …