Swallowing Recovery In Opercular Syndrome: The Role Of Automatic–Voluntary Dissociation During Speech-Language Pathology–Led Dysphagia Rehabilitation – A Case Report
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Abstract
Background: Opercular syndrome, also known as Foix–Chavany–Marie syndrome, is a rare neurological disorder characterized by automatic–voluntary dissociation, in which voluntary movements of the facial, lingual, pharyngeal, and masticatory muscles are severely impaired while involuntary and emotional movements remain relatively preserved. Dysphagia is a common and debilitating consequence, increasing the risk of aspiration, malnutrition, dehydration, and reduced quality of life. Speech-language pathology (SLP)-led dysphagia rehabilitation plays a crucial role in promoting functional swallowing recovery by utilizing preserved automatic motor pathways.
Case Presentation: This case report describes an adult patient diagnosed with opercular syndrome following bilateral opercular cortical involvement, presenting with severe dysphagia, anarthria, impaired voluntary oral motor control, and preserved automatic oral movements such as spontaneous smiling and yawning. Comprehensive swallowing assessment, including clinical bedside evaluation and instrumental findings, confirmed marked impairment in the oral and pharyngeal phases of swallowing with an increased risk of aspiration. An individualized SLP-led dysphagia rehabilitation program was implemented, emphasizing compensatory strategies, therapeutic swallowing exercises, sensory stimulation, effortful swallowing, thermal-tactile stimulation, postural modifications, and facilitation of automatic swallowing responses. Therapy also incorporated caregiver education and regular monitoring of nutritional and respiratory status.
Results: Progressive improvement in swallowing function was observed over the rehabilitation period. The patient demonstrated enhanced oral bolus control, improved initiation of the swallowing reflex, reduced aspiration episodes, and gradual advancement from modified-texture diets toward safer oral intake. Recovery appeared to be associated with the exploitation of preserved automatic motor pathways despite persistent impairment in voluntary oral motor control, highlighting the clinical significance of automatic–voluntary dissociation in rehabilitation planning.
Conclusion: This case emphasizes the importance of early, individualized, and intensive speech-language pathology intervention for dysphagia management in opercular syndrome. Understanding the neurophysiological basis of automatic–voluntary dissociation enables clinicians to design targeted rehabilitation strategies that maximize functional swallowing recovery and improve patient safety, nutritional status, and overall quality of life. Further clinical studies are warranted to establish standardized rehabilitation protocols and optimize long-term outcomes for individuals with opercular syndrome.
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References
Foix, Chavany, and Marie, “Diplégie facio-linguo-masticatrice d’origine cortico-sous-corticale sans paralysie des membres,” Revue Neurologique, vol. 61, pp. 214–219, 1926.
Daniel G. D. Weller, “Opercular syndrome: Clinical features and neuroanatomical correlates,” Journal of Neurology, Neurosurgery & Psychiatry, vol. 47, no. 2, pp. 142–148, 1984.
Michael Donzelli and Jerilyn A. Rosenbek, “Evaluation and treatment of neurogenic dysphagia,” Seminars in Speech and Language, vol. 22, no. 4, pp. 291–302, 2001.
Rebecca Leonard and Katherine Kendall, Dysphagia Assessment and Treatment Planning: A Team Approach, 4th ed. San Diego, CA, USA: Plural Publishing, 2019.
Jeri A. Logemann, Evaluation and Treatment of Swallowing Disorders, 2nd ed. Austin, TX, USA: Pro-Ed, 1998.
Maggie-Lee Huckabee and Christine Macrae, “Rethinking rehabilitation for neurogenic dysphagia,” Current Physical Medicine and Rehabilitation Reports, vol. 2, no. 4, pp. 197–206, 2014.
Michael A. Crary, Georgia Malandraki, and Catriona Steele, “Evidence-based approaches to dysphagia management,” Current Physical Medicine and Rehabilitation Reports, vol. 1, no. 4, pp. 287–294, 2013.
Joseph Murray, “Clinical management of adult dysphagia,” Perspectives of the ASHA Special Interest Groups, vol. 3, no. 13, pp. 15–24, 2018.
John C. Groher and Michael A. Crary, Dysphagia: Clinical Management in Adults and Children, 2nd ed. Maryland Heights, MO, USA: Elsevier, 2016.
Joan C. Arvedson and Linda Brodsky, Pediatric Swallowing and Feeding: Assessment and Management, 3rd ed. Albany, NY, USA: Cengage Learning, 2020.
Catriona M. Steele, “The blind scientists and the elephant of swallowing: A review of instrumented dysphagia assessment,” Journal of Texture Studies, vol. 46, no. 3, pp. 122–137, 2015.
Renée Speyer, “Effects of therapy in oropharyngeal dysphagia by speech-language pathologists: A systematic review,” Dysphagia, vol. 24, no. 1, pp. 40–65, 2009.
Renée Speyer, et al., “Neuroplasticity in dysphagia rehabilitation: Current evidence and future directions,” Current Physical Medicine and Rehabilitation Reports, vol. 10, no. 1, pp. 1–12, 2022.
Michael A. Crary, “Swallowing rehabilitation following neurological disorders,” Physical Medicine and Rehabilitation Clinics of North America, vol. 19, no. 4, pp. 889–928, 2008.
Ian J. Cook and Reza Shaker, “Physiology of swallowing and dysphagia,” Nature Reviews Gastroenterology & Hepatology, vol. 6, no. 7, pp. 393–403, 2009.
Julie A. Yoon and Georgia Malandraki, “Speech-language pathology interventions for neurogenic dysphagia,” American Journal of Speech-Language Pathology, vol. 29, no. 4, pp. 1885–1898, 2020.
Catriona M. Steele, Renée Speyer, and Michael A. Crary, “Best practices in dysphagia rehabilitation: An international perspective,” Dysphagia, vol. 37, no. 2, pp. 215–229, 2022.