Relationship between pharyngeal response time and lateralized brain lesion in stroke

Quantitative Analysis of Temporal Parameters Correlated with Aspiration and Lesion Location in Stroke Patients

The purpose of this study was to identify differences in temporal parameters correlating to the presence of aspiration and the severity of penetration-aspiration scale (PAS) in patients with dysphagia after stroke. We also investigated whether there was a significant difference in temporal parameters based on the location of the stroke lesion. A total of 91 patient videofluoroscopic swallowing study (VFSS) videos of stroke patients with dysphagia were retrospectively analyzed. Various temporal parameters including oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, upper esophageal sphincter opening duration and upper esophageal sphincter reaction time were measured. Subjects were grouped by the presence of aspiration, PAS score, and location of the stroke lesion. Pharyngeal response time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration were significantly prolonged in the aspiration group. These three factors showed positive correlation with PAS. In terms of stroke lesion, oral phase duration was significantly prolonged in the supratentorial lesion group, while upper esophageal sphincter opening duration was significantly prolonged in the infratentorial lesion group. We have demonstrated that quantitative temporal analysis of VFSS can be a clinically valuable tool identifying dysphagia pattern associated with stroke lesion or aspiration risk.

Interrater reliability in the temporal quantitative analysis of oropharyngeal swallowing using a specific software

PURPOSE

This study aims to analyze inter-judge reliability by measuring a few temporal parameters of swallowing using a specific software.

METHODS

Six databases that include the results of reliability tests performed in prior studies by the present research group were employed. The datasets were obtained using the same measurement method and include data obtained based on puree (level 3) consistency and liquid (level 0) consistency according to the International Dysphagia Diet Standardization Initiative. In this study, the reliabilities corresponding to the total oral transit time (TOTT), initiation of the pharyngeal response time (PRT), and the pharyngeal transit time (PTT) were measured using the same software; the evaluations performed by a single rater for all datasets were used as the benchmark, and evaluations performed by new raters for each dataset were also included. The intra-class correlation coefficient (ICC) with a 95% confidence interval was employed.

RESULTS

A total of 244 videofluoroscopic swallowing study images were analyzed. In all analyses, the ICCs were >0,75 and showed excellent agreement between the senior and junior raters. The TOTT for level 3 showed ICCs from 0.936 to 1.000 and that for level 0 showed ICCs from 0.997 to 1.000. Further, the PRT showed ICCs from 0.916 to 1.000 for level 3 and from 0.978 to 1.000 for level 0. The PTT showed ICCs from 0.848 to 1.000 for level 3 and from 0.984 to 1.000 for level 0.

CONCLUSION

The reliabilities obtained using this specific software for the TOTT, PRT, and PTT showed excellent agreement.