Over the past four decades, our understanding of swallowing neural control has expanded dramatically. However, until recently, advances in rehabilitation approaches for dysphagia have not kept pace, with a persistent focussing on strengthening peripheral muscle. This approach is no doubt very appropriate for some if not many of our patients. But what if the dysphagia is not due to muscles weakness? The purpose of this clinical manuscript is to reflect on where we have been, where we are now and perhaps where we need to go in terms of our understanding of swallowing motor control and rehabilitation of motor control impairments. This compilation is presented to clinicians in the hope that suggesting approaches “outside the box” will inspire clinicians to focus their attention “inside the box” to ultimately improve rehabilitation and long-term outcomes for patients with dysphagia.

Purpose of Review The purpose of this review is to consolidate evidence related to the use of biofeedback in swallowing rehabilitation. Rather than a comprehensive review, we provide a historical and conceptual justification for integration of biofeedback modalities in the treatment of dysphagia. Recent Findings Although biofeedback has been used for decades in/as an adjunct to muscle strengthening rehabilitation programmes, advances in our understanding of swallowing neural control provide potential for new applications of technology to facilitate swallowing recovery. New research highlights the emergence of skill-based swallowing training, which focuses on adaptation of specific components of timing and coordination in the swallowing motor plan. This research suggests positive clinical outcomes using feedback that is impairment specific and is designed with principles of neuroplasticity in mind. Summary The emerging emphasis on motor control, rather than muscle strength, implicates a critical role for the use of biofeedback modalities to allow conscious insights into specific aspects of the generally obscure swallowing process.