Steven Jobs is quoted "You can't connect the dots looking forward; you can only connect them looking backwards." In this lecture, we will explore the foundations of our knowledge that underlie current rehabilitation approaches for swallowing impairment and how what we have known to be true from the past is challenged with current thinking. A significant conceptual shift is underway! Many of our current rehab approaches focus on muscle strengthening, which may be very appropriate for some patients. However, this does raise the question: how many of our patients are actually weak? Critically, diagnostic modalities in dysphagia show us HOW things move or don’t move; they don’t tell us WHY. This is an important distinction, particularly given the potential for adverse effects from muscle strengthening. The resulting clinical conundrum: How does a clinician determine appropriate treatment targets for impaired physiology when our diagnostic tools show us only biomechanics? This lecture will explore emerging concepts for increasing the specificity of rehabilitation programming.

In a series of case studies, we will explore limitations of our thinking when we evaluate only impaired biomechanics. The need for models of physiology-specific rehabilitation approaches will be emphasised, encouraging clinicians to 'get outta the muscle and into the brain'! when evaluating and, very importantly, rehabilitating dysphagia. As our current state-of-the-art is lacking, a primary focus will be on clinical differentiation between deficits related to impaired strength vs impaired skill in swallowing.

The intent of this lecture is not to provide answers, but to raise many interesting and exciting questions for challenge thinking and move our clinical practice outta the past and into the future.

1. Understanding how we have developed our current approaches will challenge us to develop new approaches.
2. Not all patients are weak.
3. Biomechanics are important to consider for compensation of dysphagia, but rehabilitation that is specific to impairment requires an understanding of pathophysiology