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Lam WYS, Kwong E, Chan HWT, Zheng YP. Using Sequence Analyses to Quantitatively Measure Oropharyngeal Swallowing Temporality in Point-of-Care Ultrasound Examinations: A Pilot Study. J Clin Med 2024; 13:2288. [PMID: 38673561 PMCID: PMC11051012 DOI: 10.3390/jcm13082288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Swallowing is a complex process that comprises well-timed control of oropharyngeal and laryngeal structures to achieve airway protection and swallowing efficiency. To understand its temporality, previous research adopted adherence measures and revealed obligatory pairs in healthy swallows and the effect of aging and bolus type on the variability of event timing and order. This study aimed to (i) propose a systemic conceptualization of swallowing physiology, (ii) apply sequence analyses, a set of information-theoretic and bioinformatic methods, to quantify and characterize swallowing temporality, and (iii) investigate the effect of aging and dysphagia on the quantified variables using sequence analyses measures. (2) Method: Forty-three participants (17 young adults, 15 older adults, and 11 dysphagic adults) underwent B-mode ultrasound swallowing examinations at the mid-sagittal plane of the submental region. The onset, maximum, and offset states of hyoid bone displacement, geniohyoid muscle contraction, and tongue base retraction were identified and sorted to form sequences which were analyzed using an inventory of sequence analytic techniques; namely, overlap coefficients, Shannon entropy, and longest common subsequence algorithms. (3) Results: The concurrency of movement sequence was found to be significantly impacted by aging and dysphagia. Swallowing sequence variability was also found to be reduced with age and the presence of dysphagia (H(2) = 52.253, p < 0.001, η2 = 0.260). Four obligatory sequences were identified, and high adherence was also indicated in two previously reported pairs. These results provided preliminary support for the validity of sequence analyses for quantifying swallowing sequence temporality. (4) Conclusions: A systemic conceptualization of human deglutition permits a multi-level quantitative analysis of swallowing physiology. Sequence analyses are a set of promising quantitative measurement techniques for point-of-care ultrasound (POCUS) swallowing examinations and outcome measures for swallowing rehabilitation and evaluation of associated physiological conditions, such as sarcopenia. Findings in the current study revealed physiological differences among healthy young, healthy older, and dysphagic adults. They also helped lay the groundwork for future AI-assisted dysphagia assessment and outcome measures using POCUSs. Arguably, the proposed conceptualization and analyses are also modality-independent measures that can potentially be generalized for other instrumental swallowing assessment modalities.
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Affiliation(s)
- Wilson Yiu Shun Lam
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Elaine Kwong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Huberta Wai Tung Chan
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
| | - Yong-Ping Zheng
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Xu F, Bai L, Dai Z, Cheng H. Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis. Front Neurosci 2023; 17:1275748. [PMID: 37942140 PMCID: PMC10628302 DOI: 10.3389/fnins.2023.1275748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background Dysphagia represents one of the common complications following a stroke, and post-stroke dysphagia (PSD) can lead to aspiration, pneumonia, and malnutrition, thus prolonging hospital stay, escalating medical expenditures, and imposing a substantial economic strain on both patients and society. The utilization of bibliometric analysis offers a quantitative approach for investigating the existing literature and recognizes the current status of the research. However, bibliometric analysis on the subject of PSD remains absent. Consequently, we carried out this study to provide researchers with insights, facilitating their further exploration of PSD. Methods Conducting a bibliometric analysis of articles pertaining to PSD retrieved over the past two decades enables us to acquire the research hotspots and trends in this area. The publications concerning PSD were searched from the Core Collection of Web of Science, spanning the period ranging from 2003 to 2023. Articles or reviews published in English were included in this study. Subsequently, we employed CiteSpace and VOSviewer software to visualize the retrieved articles, thereby identifying the cooperative relationships of authors, institutions, and countries, as well as relevant information about journals and references. Results This study comprised 866 papers in total, and the number of articles published each year shows an overall growth trend. As for the analysis of the authors, Dziewas R. was the most prolific author with 21 articles. The most frequently published institutions, countries, and journals were the University of Manchester, China, and Dysphagia, with 28, 254, and 75 publications, respectively. And the co-cited authors and journals with the highest counts were Martino R and Stroke. According to the analysis of keywords and references, dysphagia screening and assessment, prevention of pneumonia, rehabilitation approaches, and nutritional management of PSD are considered research hotpots. Additionally, future research may focus on the topics of systematic review and meta-analysis, noninvasive brain stimulation, and lesion location. Conclusion Through the bibliometrics analysis of PSD, we can capture the research hotspots and frontiers of PSD, thereby providing inspiration and reference for subsequent studies in this field.
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Affiliation(s)
- Fangyuan Xu
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Lin Bai
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Ziliang Dai
- Department of Rehabilitation Medicine, Wuhan Iron and Steel (Group) Second Staff Hospital, Wuhan, China
| | - Hongliang Cheng
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Farpour S, Asadi-Shekaari M, Borhani-Haghighi A, Farpour HR, Rostamihosseinkhani M. The role of transcranial direct current stimulation in diminishing the risk of pneumonia in patients with dysphagia: A double-blinded randomized clinical trial. CURRENT JOURNAL OF NEUROLOGY 2023; 22:155-161. [PMID: 38011411 PMCID: PMC10626141 DOI: 10.18502/cjn.v22i3.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/10/2023] [Indexed: 11/29/2023]
Abstract
Background: Dysphagia can be a life-threatening issue for post-stroke patients, with aspiration pneumonia (AP) being a common risk. However, there is hope through the potential combination of transcranial direct current stimulation (tDCS) and classical behavior therapy. Our study aims to investigate the effectiveness of this combination in diminishing the risk of AP in patients with dysphagia who suffered from stroke. Methods: In this randomized, parallel-group, blinded clinical trial, 48 patients were allocated into the sham group (speech therapy + 30 seconds of tDCS) and the real group (speech therapy + 20 minutes of tDCS). We used the Mann Assessment of Swallowing Ability (MASA) as an assessment tool. We assessed patients at baseline, one day after treatment, and at a one-month follow-up. Results: Groups showed no significant difference at baseline. After treatment, the real group showed a significant difference in the severity risk of AP (P = 0.02); the same was for the follow-up (P = 0.04). The number of patients showing severe risk of AP was higher in the sham group after treatment (n = 13, 54.20%) and at follow-up (n = 4, 18.20%) than the real group (n = 4, 16.70%; n = 1, 4.50%, respectively). None of the patients reported the history of AP at any stage of assessment. Conclusion: Although the results were more promising in the real group than the sham group in reducing the risk of AP, both techniques can prevent AP. Therefore, we recommend early dysphagia management to prevent AP regardless of the treatment protocol.
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Affiliation(s)
- Sima Farpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Asadi-Shekaari
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Hamid Reza Farpour
- Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtab Rostamihosseinkhani
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Farpour S, Asadi-Shekaari M, Borhani Haghighi A, Farpour HR. Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial. Dysphagia 2023; 38:330-339. [PMID: 35715574 PMCID: PMC9205412 DOI: 10.1007/s00455-022-10470-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/21/2022] [Indexed: 01/27/2023]
Abstract
Post-stroke dysphagia is a prevalent, life threatening condition. Scientists recommended implementing behavioral therapies with new technologies such as transcranial direct current of stimulation (TDCS). Studies showed promising TDCS effects, and scientists suggested the investigation of the effectiveness of different montages. Supramarginal gyrus (SMG) is important in swallowing function. Our study aimed to investigate the effectiveness of stimulating SMG in improving post-stroke dysphagia. Forty-four patients finished the study (a randomized, double-blind one). All of them received behavioral therapy. The real group received anodal (2 mA, 20 min) stimulation on the intact SMG, and the sham group received the same for 30 s (5 sessions). Patients were assessed with Functional Oral Intake Scale (FOIS) and Mann Assessment of Swallowing Ability (MASA) after treatment and at one-month follow-up. The results showed that the difference between groups at baseline was not significant. According to MASA both groups improved significantly during the time (p-value < 0.001). The improvement in the real group was significantly higher than in the sham group after treatment (p-value = 0.002) and after one-month follow-up (p-value < 0.001). According to FOIS, most of the patients in the real group (72.70%) reached level 6 or 7 after one-month follow-up which was significantly higher than the sham group (31.80%, p-value = 0.007). In conclusion, TDCS applied to the scalp's surface associated with SMG localization may improve swallowing function in the stroke patients with dysphagia.
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Affiliation(s)
- Sima Farpour
- grid.412105.30000 0001 2092 9755Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Asadi-Shekaari
- grid.412105.30000 0001 2092 9755Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Afshin Borhani Haghighi
- grid.412571.40000 0000 8819 4698Faculty of Medicine, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Khalili Street, Shiraz, Iran
- grid.412571.40000 0000 8819 4698Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Farpour
- grid.412571.40000 0000 8819 4698Faculty of Medicine, Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Emam Hossein Street, Shiraz, Iran
- grid.412571.40000 0000 8819 4698Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
- grid.412571.40000 0000 8819 4698Shiraz Geriatrics Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Effect of Repetitive Transcranial Magnetic Stimulation on Post-stroke Dysphagia: A Meta-analysis of Stimulation Frequency, Stimulation Site, and Timing of Outcome Measurement. Dysphagia 2023; 38:435-445. [PMID: 35763122 DOI: 10.1007/s00455-022-10483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia is one of the most frequent sequelae of stroke. It can result in various complications such as malnutrition, dehydration, aspiration pneumonia, and poor rehabilitation outcomes. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve dysphagia after a stroke; however, effective treatment protocols have not been established yet. We evaluated the effect of the following rTMS parameters on post-stroke dysphagia: stimulation frequency [high frequency (≥ 3 Hz) or low frequency (1 Hz)] and stimulation site (ipsilesional or contralesional mylohyoid cortex). Outcomes were measured immediately, at 3 weeks, and at 4 weeks after the rTMS session. The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published between January 01, 1980, and December 13, 2021. Randomized controlled trials on the effects of rTMS on post-stroke dysphagia were included. Six studies were finally included in the analysis. The selected studies included 158 patients (rTMS group: 81 patients; sham group: 77 patients). Regarding the effect of high-frequency rTMS on the ipsilesional cortex, the standardized swallowing assessment (SSA) scores showed significant improvement after rTMS sessions immediately and at 4 weeks [immediate: P = 0.02, standard mean difference (SMD) = - 0.61, 95% confidence interval (CI) = - 1.14 to - 0.08; 4 weeks: P = 0.006, SMD = - 0.74, 95% CI = - 1.27 to - 0.21]; however, there was no significant reduction in the Penetration-Aspiration Scale (PAS) scores between the rTMS and sham groups (immediate: P = 0.43, SMD = 0.25, 95% CI = - 0.36, 0.86; 3 weeks: P = 0.39, SMD = 0.37, 95% CI = - 0.47 to 1.22). After low-frequency rTMS on the ipsilesional cortex, a significantly greater improvement in the SSA scores was found in the rTMS group than in the sham group, both immediately and at 4 weeks after rTMS sessions (immediate: P = 0.03, SMD = - 0.59, 95% CI = - 1.12 to - 0.06; 4 weeks: P = 0.001, SMD = - 0.92, 95% CI = - 1.48 to - 0.37). In addition, immediately after the rTMS sessions, the PAS scores were significantly reduced in the rTMS group than in the sham group (P = 0.047, SMD = - 0.60, 95% CI = - 1.19 to - 0.01). However, at 4 weeks after rTMS sessions, there was no significant reduction in the PAS scores in the rTMS group compared to the sham group (P = 0.48, SMD = - 0.19, 95% CI = - 0.71 to 0.33). Both high-frequency rTMS of the ipsilesional cortex and low-frequency rTMS of the contralesional cortex improved some measurements of the swallowing function in stroke patients immediately and at 4 weeks after treatment.
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Basagni B, Marignani S, Pancani S, Mannini A, Hakiki B, Grippo A, Macchi C, Cecchi F. Cognitive Profile in Patients Admitted to Intensive Rehabilitation after Stroke Is Associated with the Recovery of Dysphagia: Preliminary Results from the RIPS (Intensive Post-Stroke Rehabilitation) Study. Semin Speech Lang 2023; 44:15-25. [PMID: 36649702 DOI: 10.1055/s-0042-1759612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Dysphagia represents one of the most frequent symptoms in the post-acute stroke population. Swallowing impairment and cognitive deficits can often co-occur. This study aims to investigate the relationship between cognitive impairment and the recovery of dysphagia in patients attending specific rehabilitation. Patients admitted to intensive rehabilitation units were administered the Functional Oral Intake Scale (FOIS) and Montreal Cognitive Screening Test (MoCA); when screening positive for dysphagia, they entered a rehabilitation program. Their FOIS score at discharge was the primary outcome measure. In the multivariate analysis, younger age (B = - 0.077, p = 0.017), higher MoCA (B = 0.191, p = 0.002), and higher FOIS (B = 1.251, p = 0.032) at admission were associated with higher FOIS at discharge. When executive function (EF) replaced the MoCA total score in the model, younger age (B = - 0.134, p = 0.001), higher admission EF (B = 1.451, p < 0.001), and FOIS (B = 1.348, p = 0.035) were associated with higher FOIS at discharge. Our results confirm the hypothesis that a better cognitive profile upon admission is associated with a higher probability of dysphagia recovery at discharge. EF seems to have a crucial role in dysphagia recovery. These results highlight the importance of considering the cognitive profile when assessing and treating dysphagia after stroke and of using screening tests that include executive functions.
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Affiliation(s)
| | | | | | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Estupiñán Artiles C, Regan J, Donnellan C. Physiological Mechanisms and Associated Pathophysiology of Dysphagia in Older Adults. Gerontol Geriatr Med 2022; 8:23337214221142949. [PMID: 36582660 PMCID: PMC9793049 DOI: 10.1177/23337214221142949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022] Open
Abstract
Dysphagia can be a common secondary sequela of neurological and neurodegenerative disorders in older adults. Early screening, identification, and management of dysphagia is essential to avoid serious complications, including malnutrition, dehydration, aspiration pneumonia; and promote quality of life. Although individuals of all ages may experience swallowing difficulties, dysphagia and its complications are more common in older adults. This literature review aims to provide an overview of the physiological mechanisms of normal swallowing in healthy individuals and age-related changes to swallowing function, the pathophysiology of dysphagia associated with three common neurological disorders affecting older adults (stroke, Parkinson's disease, and dementia), and implications for interdisciplinary clinical practice. Increased awareness of these issues may contribute to a more timely and efficient identification of older adults with dysphagia and to improve overall dysphagia management.
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Affiliation(s)
- Constantino Estupiñán Artiles
- Trinity College Dublin, Ireland,Constantino Estupiñán Artiles, School of
Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24
D’Ollier Street, Dublin D02 T283, Ireland.
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Gallois Y, Neveu F, Gabas M, Cormary X, Gaillard P, Verin E, Speyer R, Woisard V. Can Swallowing Cerebral Neurophysiology Be Evaluated during Ecological Food Intake Conditions? A Systematic Literature Review. J Clin Med 2022; 11:jcm11185480. [PMID: 36143127 PMCID: PMC9505443 DOI: 10.3390/jcm11185480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Swallowing is a complex function that relies on both brainstem and cerebral control. Cerebral neurofunctional evaluations are mostly based on functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), performed with the individual laying down; which is a non-ecological/non-natural position for swallowing. According to the PRISMA guidelines, a review of the non-invasive non-radiating neurofunctional tools, other than fMRI and PET, was conducted to explore the cerebral activity in swallowing during natural food intake, in accordance with the PRISMA guidelines. Using Embase and PubMed, we included human studies focusing on neurofunctional imaging during an ecologic swallowing task. From 5948 unique records, we retained 43 original articles, reporting on three different techniques: electroencephalography (EEG), magnetoencephalography (MEG) and functional near infra-red spectroscopy (fNIRS). During swallowing, all three techniques showed activity of the pericentral cortex. Variations were associated with the modality of the swallowing process (volitional or non-volitional) and the substance used (mostly water and saliva). All techniques have been used in both healthy and pathological conditions to explore the precise time course, localization or network structure of the swallowing cerebral activity, sometimes even more precisely than fMRI. EEG and MEG are the most advanced and mastered techniques but fNIRS is the most ready-to-use and the most therapeutically promising. Ongoing development of these techniques will support and improve our future understanding of the cerebral control of swallowing.
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Affiliation(s)
- Yohan Gallois
- Laboratory LNPL—UR4156, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
- ENT, Otoneurology and Pediatric ENT Department, Pierre Paul Riquet Hospital, University Hospital of Toulouse, 31059 Toulouse, France
- Correspondence: ; Tel.: +33-561772039
| | - Fabrice Neveu
- Independent Researcher, Swallis Medical, 31770 Colomiers, France
| | - Muriel Gabas
- Laboratory CERTOP—UMR CNRS 5044, Maison de la Recherche, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
| | | | - Pascal Gaillard
- Laboratory CLLE CNRS UMR5263, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, 76000 Rouen, France
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Virginie Woisard
- Laboratory LNPL—UR4156, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, 31059 Toulouse, France
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Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
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Dai M, Qiao J, Wei X, Chen H, Shi Z, Dou Z. Increased cortical-medulla functional connectivity is correlated with swallowing in dysphagia patients with subacute infratentorial stroke. NEUROIMAGE: CLINICAL 2022; 35:103104. [PMID: 35792418 PMCID: PMC9421453 DOI: 10.1016/j.nicl.2022.103104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with infratentorial stroke showed increased cortex-medulla connectivity. The cortex-medulla functional connectivities were related to swallowing function. The identified regions may be candidates for non-invasive strategies for dysphagia. FC mapping using the medulla as a seed is useful in swallowing network research.
Patients with infratentorial stroke (IS) exhibit more severe dysphagia and a higher risk of aspiration than patients with supratentorial stroke. Nevertheless, a large proportion of patients with IS regain swallowing function within 6 months; however, the neural mechanism for this recovery remains unclear. We aimed to investigate possible neuroplastic changes involved using functional magnetic resonance imaging (fMRI) and their relation to swallowing function. We assessed 21 patients with IS (mean age: 59.9 ± 11.1 years) exhibiting dysphagia in the subacute phase and 21 healthy controls (mean age: 57.1 ± 7.8 years). Patient evaluations were based on the functional oral intake scale (FOIS), videofluoroscopic swallow study (VFSS), and fMRI. Temporal swallowing measures and the penetration-aspiration scale (PAS) were obtained using VFSS. Whole-brain–medulla resting-state functional connectivity (rsFC) was calculated and compared between patients and healthy controls. The rsFCs were also correlated with functional measures within the patient group. In patients with IS, whole-brain–medulla rsFCs were significantly higher in the precuneus, the left and right precentral gyrus, and the right supplementary motor area compared to those in healthy controls (P < 0.001, family-wise error-corrected cluster-level P < 0.05). The rsFCs to the medulla for the left (r = −0.507, P = 0.027) and right side (r = −0.503, P = 0.028) precentral gyrus were negatively correlated with the PAS. The rsFC between the left (r = 0.470, P = 0.042) and right (r = 0.459, P = 0.048) precentral gyrus to the medulla was positively correlated with upper esophageal sphincter opening durations (UOD). In addition, PAS was also correlated with UOD (r = −0.638, P = 0.003) whereas the laryngeal closure duration was correlated with the hyoid bone movement duration (r = 0.550, P = 0.015). Patients with IS exhibited overall modulation of cortical-medulla connectivity during the subacute phase. Patients with higher connectivities showed better swallowing performance. These findings support that there is cortical involvement in swallowing regulation after IS and can aid in determining potential treatment targets for dysphagia.
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Affiliation(s)
- Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Huayu Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zhonghui Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China.
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11
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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12
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Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tractography study. Dysphagia 2020; 36:680-688. [PMID: 32865624 DOI: 10.1007/s00455-020-10182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
We investigated the capacity for dysphagia prognosis prediction using diffusion tensor tractography (DTT) to assess the state of the corticobulbar tract (CBT) during the initial period following lateral medullary infarction (LMI). Twenty patients with LMI and 20 control subjects were recruited for this study. The patients were classified into two subgroups: subgroup A (16 patients with nasogastric tube required for six months or less after LMI onset) and subgroup B (4 patients with nasogastric tube required for more than six months after onset). DTT was used to reconstruct the CBTs of each patient and control subject, and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained. In the affected hemisphere, the FA value of the CBT was significantly lower in subgroup B than in subgroup A and the control group (p < 0.05), with no significant difference between subgroup A and the control group. In the affected and unaffected hemispheres, the TV values of CBT in subgroups A and B were lower than those of the control group (p < 0.05), with no significant difference between subgroups A and B. In addition, among the four patients of subgroup B, reconstruction of the CBT was not possible in three patients, and the remaining patients exhibited on old lesion in the corona radiate involving descending pathway of the CBT in the affected hemisphere. We found that the injury severity of the CBT in the affected hemisphere appeared to be related to a poor dysphagia prognosis following LMI. Our results suggest that evaluation of the CBT state during the early post-LMI could be useful for dysphagia prognosis prediction.
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Im S, Han YJ, Kim SH, Yoon MJ, Oh J, Kim Y. Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke. Eur J Neurol 2020; 27:2158-2167. [PMID: 32524719 DOI: 10.1111/ene.14387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke. METHODS Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity. RESULTS The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976). CONCLUSIONS The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.
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Affiliation(s)
- S Im
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - Y J Han
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - M-J Yoon
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - J Oh
- Rehabilitation Medicine, Independent Scholar, Seoul, Korea
| | - Y Kim
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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14
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Umay EK, Yilmaz V, Gundogdu I, Ozturk E, Gurcay E, Karaahmet O, Saylam G, Ceylan T, Cakci A. What Happens to Swallowing Muscles after Stroke?: A Prospective Randomized Controlled Electrophysiological Study. Neurol India 2020; 67:1459-1466. [PMID: 31857535 DOI: 10.4103/0028-3886.273645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Stroke is the most frequent reason of neurological dysphagia Electrophysiological studies can be used to evaluate oral, pharyngeal and initial phase of esophageal phase. Aims This study aims to noninvasively evaluate mastication, mimic, and tongue muscles of stroke patients, which play an important role in the oral phase of swallowing process and compare them with healthy individuals. Setting and Design This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between January 2014 and December 2016. Materials and Methods Fifty-one patients who were admitted to our clinic with stroke and 51 healthy individuals were evaluated for the study. Demographic features of individuals were recorded. The swallowing intervals and motor action potentials (MAPs) of trigeminal, facial and hypoglossal nerves were measured. After four weeks of treatment schedule, patients were re-evaluated. Statistical Analysis The Wilcoxon Signed Rank test, the Mann-Whitney U test and Fisher exact test were used in this study. Results The all swallowing intervals were found prolonged compared to the healthy controls (P < 0.05). The MAPs of the masseter, orbicularis oculi, and intrinsic tongue muscles were significantly lower in patient group (P < 0.05). After treatment, we found significant improvement for all parameters in patient group, but the swallowing intervals were still significantly prolonged, and MAPs of these muscles were still lower (P < 0.05). Conclusion Although swallowing is examined as different phases, the process is complicated and should be evaluated totally. In post-stroke dysphagia, oral phase of swallowing process is as important as phayngeal phase and perioral, mastication, and tongue muscles are influenced even in an early period as a month.
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Affiliation(s)
- Ebru Karaca Umay
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Volkan Yilmaz
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ibrahim Gundogdu
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Erhan Ozturk
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Eda Gurcay
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ozgur Karaahmet
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Guleser Saylam
- Otolaryngology-Head and Neck Surgery Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Tijen Ceylan
- Otolaryngology-Head and Neck Surgery Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Aytul Cakci
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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15
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Lo YK, Fu TC, Chen CP, Yuan SS, Hsu CC. Involvement of swallowing therapy is associated with improved long-term survival in patients with post-stroke dysphagia. Eur J Phys Rehabil Med 2020; 55:728-734. [PMID: 31958220 DOI: 10.23736/s1973-9087.19.05893-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The effects of swallowing therapy (ST) on long-term clinical outcomes in patients with post-stroke dysphagia (PSD) remain unclear. AIM This study explores the effect of ST, initiated within 6 months of the stroke onset, on long-term pneumonia-free and overall survival rates in PSD patients. DESIGN Retrospective cohort study. SETTING Longitudinal Health Insurance Database. POPULATION The study included 2994 eligible PSD patients between 2005 and 2013. METHODS Among the scrutinized PSD patients, ST was initiated during the nasogastric intubation (NGI) period and was implemented by physician discretion. Therefore, subjects who underwent ST were classified into the ST-intervention (STI) group and those without ST were classified into the non-ST (NST) group. Propensity score matching (PSM) was used to match age, sex, pneumonia events during the NGI period, the Charlson comorbidity index, and the National Institutes of Health Stroke Scale between the two groups. We started to follow all selected PSD patients 6 months after the onset of stroke for four years. Multivariable adjusted Cox regression and Kaplan-Meier estimations were conducted to assess the effects of ST and the ST duration on pneumonia-free and overall survival. RESULTS Overall, 1497 PSD patients aged approximately 68 years in each group were selected in this study. The pneumonia-free survival rate in STI subjects was 57.4% and was significantly greater (P=0.003) than that (54.2%) in NST subjects during the follow-up (F/U). A significantly improved (P<0.0001) overall survival rate was observed in STI subjects (75.0%) compared to NST subjects (63.7%) during the F/U. In STI subjects, ST duration ≥ 1 month was significantly (P=0.009) associated with reduced pneumonia incidence compared to those with ST duration<1 month. CONCLUSIONS Participation of ST within 6 months of the stroke onset is associated with decreased pneumonia incidence and improved long-term survival in selected PSD patients. In the selected STI subjects, longer ST duration may be valuable in pneumonia prevention. CLINICAL REHABILITATION IMPACT This study reveals that ST initiated within 6 months of the stroke onset may be associated with improved long-term survival in selected PSD patients.
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Affiliation(s)
- Yu-Kuan Lo
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Carl P Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan - .,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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Warnecke T, Muhle P, Claus I, Schröder JB, Labeit B, Lapa S, Suntrup-Krueger S, Dziewas R. Inter-rater and test-retest reliability of the "standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients". Neurol Res Pract 2020; 2:9. [PMID: 33324915 PMCID: PMC7650070 DOI: 10.1186/s42466-020-00055-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the "Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients" (SESETD) - a stepwise evaluation of 'secretion management', 'spontaneous swallows' and 'laryngeal sensibility/cough' - has been introduced. With the recent study detailed data on inter-rater and test-retest reliability are presented. Methods To obtain inter-rater reliability levels both in a group of raters with at least 5 years of experience ('experts') and in a group of raters with no or only minor experience using the SESETD ('non-experts'), for each single item of the protocol and the sum score α-, respectively κ-levels were determined. The 'experts' assessed the same videos after a four-week interval to determine test-retest reliability. Ten videos from tracheostomized neurological patients completely weaned from mechanical ventilation were assessed independently by six 'experts'. 27 'non-experts' applied the SESETD on 5 videos from the same patient population after introduction to the protocol in a one-hour workshop. Results For the items 'secretion management' and 'spontaneous swallows' α-levels were identified at > 0.800 both in the group of 'experts' and 'non-experts'. With regard to the item 'laryngeal sensibility/cough' in both groups, the α-level was ≥0.667. With κ-levels of 1.0 for 'secretion management', 0.93 for 'spontaneous swallows' and 0.76 for 'laryngeal sensibility/cough' test-retest reliability showed at least substantial agreement for each item. Intraclass correlation coefficient for the sum score was excellent in both groups (α ≥ 0.90). Conclusions The SESETD demonstrates good to excellent agreement for each single item included as well as the sum score in experienced and unexperienced raters supporting its usefulness for implementation in daily clinical routine and as an outcome measure for clinical trials.
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Affiliation(s)
- Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany
| | - Jens B Schröder
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany
| | - Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany
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Lin CS. Functional Adaptation of Oromotor Functions and Aging: A Focused Review of the Evidence From Brain Neuroimaging Research. Front Aging Neurosci 2020; 11:354. [PMID: 31998112 PMCID: PMC6962247 DOI: 10.3389/fnagi.2019.00354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
“Practice makes perfect” is a principle widely applied when one is acquiring a new sensorimotor skill to cope with challenges from a new environment. In terms of oral healthcare, the traditional view holds that restoring decayed structures is one of the primary aims of treatment. This assumes that the patient’s oromotor functions would be recovered back to normal levels after the restoration. However, in older patients, such a structural–functional coupling after dental treatment shows a great degree of individual variations. For example, after prosthodontic treatment, some patients would adapt themselves quickly to the new dentures, while others would not. In this Focused Review, I argue that the functional aspects of adaptation—which would be predominantly associated with the brain mechanisms of cognitive processing and motor learning—play a critical role in the individual differences in the adaptive behaviors of oromotor functions. This thesis is critical to geriatric oral healthcare since the variation in the capacity of cognitive processing and motor learning is critically associated with aging. In this review, (a) the association between aging and the brain-stomatognathic axis will be introduced; (b) the brain mechanisms underlying the association between aging, compensatory behavior, and motor learning will be briefly summarized; (c) the neuroimaging evidence that suggests the role of cognitive processing and motor learning in oromotor functions will be summarized, and critically, the brain mechanisms underlying mastication and swallowing in older people will be discussed; and (d) based on the current knowledge, an experimental framework for investigating the association between aging and the functional adaptation of oromotor functions will be proposed. Finally, I will comment on the practical implications of this framework and postulate questions open for future research.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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18
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Evaluation of burden and depression among caregivers of stroke patients: The role of percutaneous endoscopic gastrostomy feeding tube. Clin Nutr ESPEN 2019; 33:154-157. [PMID: 31451253 DOI: 10.1016/j.clnesp.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Malnutrition problems are very common after a stroke. Several clinical studies have shown the contribution of percutaneous endoscopic gastrostomy (PEG) feeding after stroke in terms of improving nutritional status and reducing mortality. The aim of this study is to compare the burden and depression among caregivers of ischemic stroke patients fed with PEG and orally. METHODS A total of 63 caregivers of patients with acute ischemic stroke who were followed up in the neurointensive care unit with modified Rankin Scale 4 or 5 were recruited in this cross-sectional survey. Clinical data of patients and demographical profile as age, gender, kinship to patient, income, and level of education of caregivers were recorded. On their 3rd-month follow-up visit, Beck Depression Inventory and The Zarit Burden Interview (ZBI) were administered to caregivers to evaluate depressive symptoms and caregiver burden. A semi-structured questionnairre was developed and conducted by the researchers with the caregivers to assess their thoughts of nutrition. RESULTS Thirty-two caregivers of stroke patients on PEG and 31 caregivers of stroke patients who were fed orally were evaluated. The groups did not differ statistically in terms of demographic variables and depression scores (p > 0.05). However, the mean score of ZBI was significantly higher in the group of caregivers of stroke patients who were fed orally (p = 0.00). Caregivers of stroke patients on PEG had higher scores of caregivers' thoughts of nutrition support therapy questionnairre (p = 0.00). CONCLUSIONS Our findings demonstrate that caregivers of stroke patients report lower burden and higher level of positive thinking with PEG feeding than oral feeding. This suggests that nutritional care could include convenient and practicable methods for caregivers of patients with stroke in order to meet patients' nutritional requirements.
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Arreola V, Vilardell N, Ortega O, Rofes L, Muriana D, Palomeras E, Álvarez-Berdugo D, Clavé P. Natural History of Swallow Function during the Three-Month Period after Stroke. Geriatrics (Basel) 2019; 4:geriatrics4030042. [PMID: 31324004 PMCID: PMC6787737 DOI: 10.3390/geriatrics4030042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023] Open
Abstract
Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.
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Affiliation(s)
- Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Natàlia Vilardell
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, 08036 Barcelona, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Desiree Muriana
- Neurology Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Ernest Palomeras
- Neurology Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Daniel Álvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, 08036 Barcelona, Spain.
- Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, 08916 Badalona, Spain.
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Alves TC, Cola PC, Jorge AG, Gatto AR, Da Silva RG. Relationship between pharyngeal response time and lateralized brain lesion in stroke. Top Stroke Rehabil 2019; 26:435-439. [PMID: 31154954 DOI: 10.1080/10749357.2019.1623519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p = .673; B: p = 1.000) and longer (A: p = .435; B: p = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p = .260; B: p = .732) and G2 (A: p = .586; B: p = .104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.
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Affiliation(s)
- Thaís Coelho Alves
- a Dysphagia Research Rehabilitation Center; Graduate of Speech, Language and Hearing Sciences Department, São Paulo State University-UNESP , Marília , SP , Brazil
| | - Paula Cristina Cola
- b Medicine Department, Marília University - UNIMAR , Marília , SP , Brazil.,c Dysphagia Research Rehabilitation Center, São Paulo State University-UNESP , Marília , SP , Brazil
| | - Adriana Gomes Jorge
- d Speech, Language and Hearing Sciences Department, Bauru State Hospital , Bauru , SP , Brazil
| | - Ana Rita Gatto
- c Dysphagia Research Rehabilitation Center, São Paulo State University-UNESP , Marília , SP , Brazil
| | - Roberta Gonçalves Da Silva
- a Dysphagia Research Rehabilitation Center; Graduate of Speech, Language and Hearing Sciences Department, São Paulo State University-UNESP , Marília , SP , Brazil
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Tomsen N, Ortega O, Rofes L, Arreola V, Martin A, Mundet L, Clavé P. Acute and subacute effects of oropharyngeal sensory stimulation with TRPV1 agonists in older patients with oropharyngeal dysphagia: a biomechanical and neurophysiological randomized pilot study. Therap Adv Gastroenterol 2019; 12:1756284819842043. [PMID: 31068978 PMCID: PMC6492367 DOI: 10.1177/1756284819842043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/12/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Older people with oropharyngeal dysphagia (OD) present a decline in pharyngeal sensory function. The aim of this proof-of-concept study was to assess the biomechanical and neurophysiological effects of acute and subacute oropharyngeal sensory stimulation with transient receptor potential vanilloid 1 (TRPV1) agonists (capsaicinoids) in older patients with OD. METHODS We studied the effect of a single dose versus multiple doses (2 weeks) of oral capsaicin treatment (10-5 M) or placebo in 28 older patients with OD (81.2 ± 4.6 years) using videofluoroscopy (penetration-aspiration scale [PAS], timing of swallow response) and electroencephalography (EEG) (latency and amplitude of pharyngeal event-related potential [ERP]). RESULTS Acute stimulation by capsaicinoids 10-5 M did not improve swallow function and did not produce significant changes in pharyngeal ERP. In contrast, after 10 days of treatment, patients presented a clinically relevant and statistically significant reduction in the laryngeal vestibule closure (LVC) time (22.5%, p = 0.042), and in the PAS (24.2%, p = 0.038), compared with the placebo group. EEG results showed a reduction in the latency of the N1 peak (28.6%, p = 0.007) and an increase of the amplitude of the P1-N2 (59.4%, p = 0.038) and the N2-P2 (43.6%, p = 0.050) peaks. We observed a strong and significant correlation between the reduction in the latency of the N1 peak and change in LVC time after subacute treatment (r = 0.750, p = 0.003). CONCLUSIONS After 2 weeks of treatment, oropharyngeal sensory stimulation with capsaicinoids induced cortical changes that were correlated with improvements in swallowing biomechanics in older patients with OD. These results further show that sensory stimulation by TRPV1 agonists can become a useful pharmacological treatment for older patients with OD.
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Affiliation(s)
- Noemí Tomsen
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Omar Ortega
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de
enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos
III, Barcelona, Spain
| | - Viridiana Arreola
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
| | - Alberto Martin
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
| | - Lluís Mundet
- Laboratori de Fisiologia Digestiva CIBERehd
CSdM-UAB, Hospital de Mataró, Barcelona, Spain
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Neurophysiological Adaptation and Neuromodulatory Treatment Approaches in Patients Suffering from Post-stroke Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0201-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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COSTA MMB. NEURAL CONTROL OF SWALLOWING. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:61-75. [DOI: 10.1590/s0004-2803.201800000-45] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 11/21/2022]
Abstract
ABSTRACT BACKGROUND: Swallowing is a motor process with several discordances and a very difficult neurophysiological study. Maybe that is the reason for the scarcity of papers about it. OBJECTIVE: It is to describe the chewing neural control and oral bolus qualification. A review the cranial nerves involved with swallowing and their relationship with the brainstem, cerebellum, base nuclei and cortex was made. METHODS: From the reviewed literature including personal researches and new observations, a consistent and necessary revision of concepts was made, not rarely conflicting. RESULTS AND CONCLUSION: Five different possibilities of the swallowing oral phase are described: nutritional voluntary, primary cortical, semiautomatic, subsequent gulps, and spontaneous. In relation to the neural control of the swallowing pharyngeal phase, the stimulus that triggers the pharyngeal phase is not the pharyngeal contact produced by the bolus passage, but the pharyngeal pressure distension, with or without contents. In nutritional swallowing, food and pressure are transferred, but in the primary cortical oral phase, only pressure is transferred, and the pharyngeal response is similar. The pharyngeal phase incorporates, as its functional part, the oral phase dynamics already in course. The pharyngeal phase starts by action of the pharyngeal plexus, composed of the glossopharyngeal (IX), vagus (X) and accessory (XI) nerves, with involvement of the trigeminal (V), facial (VII), glossopharyngeal (IX) and the hypoglossal (XII) nerves. The cervical plexus (C1, C2) and the hypoglossal nerve on each side form the ansa cervicalis, from where a pathway of cervical origin goes to the geniohyoid muscle, which acts in the elevation of the hyoid-laryngeal complex. We also appraise the neural control of the swallowing esophageal phase. Besides other hypotheses, we consider that it is possible that the longitudinal and circular muscular layers of the esophagus display, respectively, long-pitch and short-pitch spiral fibers. This morphology, associated with the concept of energy preservation, allows us to admit that the contraction of the longitudinal layer, by having a long-pitch spiral arrangement, would be able to widen the esophagus, diminishing the resistance to the flow, probably also by opening of the gastroesophageal transition. In this way, the circular layer, with its short-pitch spiral fibers, would propel the food downwards by sequential contraction.
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Huang YC, Hsu TW, Leong CP, Hsieh HC, Lin WC. Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy. Front Neurosci 2018; 12:488. [PMID: 30079009 PMCID: PMC6062613 DOI: 10.3389/fnins.2018.00488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia. Methods: We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment. Results: FOIS (p = 0.003 in hemispheric group and p = 0.039 in brainstem group) and FDS (p = 0.006 in hemispheric group and p = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI. Conclusion: Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.
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Affiliation(s)
- Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tun-Wei Hsu
- Department of Diagnostic Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Han-Chin Hsieh
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Zeng Y, Yip J, Cui H, Guan L, Zhu H, Zhang W, Du H, Geng X. Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia. Neurol Res 2018; 40:473-479. [PMID: 29726748 DOI: 10.1080/01616412.2018.1451015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.
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Affiliation(s)
- Yanfang Zeng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - James Yip
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Hongli Cui
- c Department of General Surgery , Beijing Chuiyangliu Hospital , Beijing , China
| | - Longfei Guan
- d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
| | - Haomeng Zhu
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Weidong Zhang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Huishan Du
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xiaokun Geng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA.,d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
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Neural Mechanisms of Swallowing Dysfunction and Apraxia of Speech in Acute Stroke. Dysphagia 2018; 33:610-615. [PMID: 29478192 DOI: 10.1007/s00455-018-9879-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
Speech and swallowing utilize overlapping anatomy and are thus inherently related processes. We sought to identify common neural mechanisms between risk of swallowing dysfunction and apraxia of speech (AOS). This was a retrospective analysis using data from a prospectively collected cohort. Left hemisphere stroke patients (68 subjects) tested with the Apraxia Battery for Adults II, a swallow screen, and MRI were included in the study. Main outcome measure was the presence of AOS or aspiration risk after stroke. We identified a significant association between AOS measures and increased aspiration risk (defined by failed swallow screen; p = 0.04; OR 5.2). Lesions in pars opercularis of Broca's area (BA 44) were associated with both AOS (p = 0.044; OR 9.7) and increased aspiration risk (p = 0.04; OR 5) but deficits rarely co-occurred in the same cases. Lesions in left premotor cortex (BA 6) were not significantly associated with increased aspiration risk (p = 0.06; OR 3.3) but were significantly associated with AOS (p = 0.008; OR 7). Impaired swallowing function was also associated with lesions in Wernicke's area (BA 22; p = 0.05; OR 3.5) and pars triangularis (BA 45; p = 0.02; OR 6.8). AOS and risk of aspiration are associated in patients with acute left hemisphere stroke. Acute infarct in the pars opercularis of Broca's area is associated with both deficits, though they rarely co-occur in the same individual. The co-occurrence of AOS and risk of aspiration likely reflects dependence on closely related neural structures.
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Suntrup-Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U, Claus I, Warnecke T, Teismann I, Pantev C, Dziewas R. Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol 2018; 83:328-340. [PMID: 29350775 DOI: 10.1002/ana.25151] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We evaluated whether transcranial direct current stimulation (tDCS) is able to enhance dysphagia rehabilitation following stroke. Besides relating clinical effects with neuroplastic changes in cortical swallowing processing, we aimed to identify factors influencing treatment success. METHODS In this double-blind, randomized study, 60 acute dysphagic stroke patients received contralesional anodal (1mA, 20 minutes) or sham tDCS on 4 consecutive days. Swallowing function was thoroughly assessed before and after the intervention using the validated Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and clinical assessment. In 10 patients, swallowing-related brain activation was recorded applying magnetoencephalography before and after the intervention. Voxel-based statistical lesion pattern analysis was also performed. RESULTS Study groups did not differ according to demographic data, stroke characteristics, or baseline dysphagia severity. Patients treated with tDCS showed greater improvement in FEDSS than the sham group (1.3 vs 0.4 points, mean difference = 0.9, 95% confidence interval [CI] = 0.4-1.4, p < 0.0005). Functional recovery was accompanied by a significant increase of activation (p < 0.05) in the contralesional swallowing network after real but not sham tDCS. Regarding predictors of treatment success, for every hour earlier that treatment was initiated, there was greater improvement on the FEDSS (adjusted odds ratio = 0.99, 95% CI = 0.98-1.00, p < 0.05) in multivariate analysis. Stroke location in the right insula and operculum was indicative of worse response to tDCS (p < 0.05). INTERPRETATION Application of tDCS over the contralesional swallowing motor cortex supports swallowing network reorganization, thereby leading to faster rehabilitation of acute poststroke dysphagia. Early treatment initiation seems beneficial. tDCS may be less effective in right-hemispheric insulo-opercular stroke. Ann Neurol 2018;83:328-340.
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Affiliation(s)
- Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster.,Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster
| | | | - Paul Muhle
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster.,Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster
| | - Andre Kemmling
- Institute of Neuroradiology, University Hospital Lübeck, Lübeck
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster
| | - Inga Teismann
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster
| | - Christo Pantev
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1 Münster
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Henke C, Foerch C, Lapa S. Early Screening Parameters for Dysphagia in Acute Ischemic Stroke. Cerebrovasc Dis 2017; 44:285-290. [PMID: 28903096 DOI: 10.1159/000480123] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 07/27/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke. METHODS Our analysis was based on data from a prospective in-hospital registry. Patients with ischemic stroke were included over the course of 3 years. Patients were scheduled to undergo a clinical swallowing investigation within the first 24 h after hospital admission. Step-wise multivariate logistic regression was used to identify independent predictors of dysphagia in general and of pneumonia in particular. RESULTS 1,646 patients with ischemic stroke were included. Stroke severity in terms of higher National Institute of Health Stroke Scale (NIHSS) values (p < 0.001), male gender (p = 0.006) and higher age (p < 0.001) independently predicted dysphagia. A receiver operating characteristics analysis revealed an NIHSS cut-off value of 4.5 for optimal differentiation between patients with and without dysphagia (sensitivity 0.77; specificity 0.77). Dysphagia (p < 0.001), male gender (p = 0.002), higher NIHSS scores (p < 0.001) and higher age (p = 0.002) were factors that were independently associated with pneumonia. The NIHSS cut-off value for differentiating between patients with and without pneumonia was 5.5 (sensitivity 0.91; specificity 0.67). CONCLUSIONS Stroke severity in terms of NIHSS is a simple and reliable predictor of dysphagia. Patients with NIHSS values ≥5 should be quickly directed towards a professional swallowing examination. Dysphagia was confirmed to be a strong predictor of pneumonia.
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Affiliation(s)
- Christian Henke
- Department of Neurology, HELIOS HSK Wiesbaden, Wiesbaden, Germany
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The Role of the Corpus Callosum in Pediatric Dysphagia: Preliminary Findings from a Diffusion Tensor Imaging Study in Children with Unilateral Spastic Cerebral Palsy. Dysphagia 2017; 32:703-713. [DOI: 10.1007/s00455-017-9816-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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Yuan Y, Wang J, Wu D, Huang X, Song W. Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients. Top Stroke Rehabil 2017; 24:503-509. [PMID: 28476095 DOI: 10.1080/10749357.2017.1322250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Swallowing apraxia is characterized by impaired volitional swallowing but relatively preserved reflexive swallowing. Few studies are available on the effectiveness of behavioral therapy and management of the condition. OBJECTIVE This study aimed to investigate the effect of transcranial direct current stimulation (tDCS) on swallowing apraxia and cortical activation in stroke patients. METHODS The study included three inpatients (age 48-70 years; 1 male, 2 females; duration of stroke, 35-55 d) with post-stroke swallowing apraxia and six age-matched healthy subjects (age 45-65 years; 3 males, 3 females). Treatments were divided into two phases: Phase A and Phase B. During Phase A, the inpatients received three weeks of sham tDCS and conventional treatments. During Phase B, these patients received three weeks of anodal tDCS over the bilateral primary sensorimotor cortex (S1M1) of swallowing and conventional treatments. Swallowing apraxia assessments were measured in three inpatients before Phase A, before Phase B, and after Phase B. The electroencephalography (EEG) nonlinear index of approximate entropy (ApEn) was calculated for three patients and six healthy subjects. RESULTS After tDCS, scores of swallowing apraxia assessments increased, and ApEn indices increased in both stimulated and non-stimulated areas. CONCLUSIONS Anodal tDCS might provide a useful means for recovering swallowing apraxia, and the recovery could be related to increased excitability of the swallowing cortex. Further investigations should explore the relationship between lesion size and/or lesion site and the prognosis of swallowing apraxia. Clinical trial registry: http://www.chictr.org Registration Number: ChiCTR-TRC-14004955.
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Affiliation(s)
- Ying Yuan
- a Department of Rehabilitation , Xuanwu Hospital Capital Medical University , Beijing , China
| | - Jie Wang
- a Department of Rehabilitation , Xuanwu Hospital Capital Medical University , Beijing , China
| | - Dongyu Wu
- b Department of Rehabilitation , Wangjing Hospital of China Academy of Chinese Medical Science, Wangjing Hospital , Beijing , China
| | - Xiaobo Huang
- c Department of Traditional Chinese Medicine , Xuanwu Hospital Capital Medical University , Beijing , China
| | - Weiqun Song
- a Department of Rehabilitation , Xuanwu Hospital Capital Medical University , Beijing , China
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May NH, Pisegna JM, Marchina S, Langmore SE, Kumar S, Pearson WG. Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke. J Stroke Cerebrovasc Dis 2017; 26:952-961. [PMID: 27913200 PMCID: PMC5409864 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/21/2016] [Accepted: 11/02/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Computational analysis of swallowing mechanics (CASM) is a method that utilizes multivariate shape change analysis to uncover covariant elements of pharyngeal swallowing mechanics associated with impairment using videofluoroscopic swallowing studies. The goals of this preliminary study were to (1) characterize swallowing mechanics underlying stroke-related dysphagia, (2) decipher the impact of left and right hemispheric strokes on pharyngeal swallowing mechanics, and (3) determine pharyngeal swallowing mechanics associated with penetration-aspiration status. METHODS Videofluoroscopic swallowing studies of 18 dysphagic patients with hemispheric infarcts and age- and gender-matched controls were selected from well-controlled data sets. Patient data including laterality and penetration-aspiration status were collected. Coordinates mapping muscle group action during swallowing were collected from videos. Multivariate morphometric analyses of coordinates associated with stroke, affected hemisphere, and penetration-aspiration status were performed. RESULTS Pharyngeal swallowing mechanics differed significantly in the following comparisons: stroke versus controls (D = 2.19, P < .0001), right hemispheric stroke versus controls (D = 3.64, P < .0001), left hemispheric stroke versus controls (D = 2.06, P < .0001), right hemispheric stroke versus left hemispheric stroke (D = 2.89, P < .0001), and penetration-aspiration versus within normal limits (D = 2.25, P < .0001). Differences in pharyngeal swallowing mechanics associated with each comparison were visualized using eigenvectors. CONCLUSIONS Whereas current literature focuses on timing changes in stroke-related dysphagia, these data suggest that mechanical changes are also functionally important. Pharyngeal swallowing mechanics differed by the affected hemisphere and the penetration-aspiration status. CASM can be used to identify patient-specific swallowing impairment associated with stroke injury that could help guide rehabilitation strategies to improve swallowing outcomes.
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Affiliation(s)
- Nelson H May
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jessica M Pisegna
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Susan E Langmore
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sandeep Kumar
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - William G Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Lin J, Chen Y, Wen H, Yang Z, Zeng J. Weakness of Eye Closure with Central Facial Paralysis after Unilateral Hemispheric Stroke Predicts a Worse Outcome. J Stroke Cerebrovasc Dis 2017; 26:834-841. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/01/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022] Open
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Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia. Brain Stimul 2017; 10:75-82. [DOI: 10.1016/j.brs.2016.08.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/28/2016] [Accepted: 08/06/2016] [Indexed: 11/23/2022] Open
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Cabib C, Ortega O, Kumru H, Palomeras E, Vilardell N, Alvarez-Berdugo D, Muriana D, Rofes L, Terré R, Mearin F, Clavé P. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann N Y Acad Sci 2016; 1380:121-138. [DOI: 10.1111/nyas.13135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Cabib
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Hatice Kumru
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
| | - Ernest Palomeras
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Natalia Vilardell
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Desirée Muriana
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Rosa Terré
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Fermín Mearin
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
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Dehaghani SE, Yadegari F, Asgari A, Chitsaz A, Karami M. Brain regions involved in swallowing: Evidence from stroke patients in a cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:45. [PMID: 27904591 PMCID: PMC5122214 DOI: 10.4103/1735-1995.183997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/23/2015] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
Background: Limited data available about the mechanisms of dysphagia and areas involving swallow after brain damage; accordingly it is hard to predict which cases are more likely to develop swallowing dysfunction based on the neuroimaging. The aim of this study was to investigate the relationship between brain lesions and dysphagia in a sample of acute conscious stroke patients. Materials and Methods: In a cross-sectional study, 113 acute conscious stroke patients (69 male mean [standard deviation (SD)] age 64.37 [15.1]), participated in this study. Two neurologists and one radiologist localized brain lesions according to neuroimaging of the patients. Swallowing functions were assessed clinically by an expert speech pathologist with the Mann Assessment of Swallowing Ability (MASA). The association of brain region and swallowing problem was statistically evaluated using Chi-square test. Results: Mean (SD) MASA score for the dysphagic patients was 139.61 (29.77). Swallowing problem was significantly more prevalent in the right primary sensory (P = 0.03), right insula (P = 0.005), and right internal capsule (P = 0.05). Conclusion: It may be concluded from these findings that the right hemisphere lesions associated with occurring dysphagia. Further studies using more advanced diagnostic tools on big samples particularly in a perspective structure are needed.
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Affiliation(s)
- Shiva Ebrahimian Dehaghani
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Speech Therapy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Yadegari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Asgari
- Department of Psychology, Kharazmi University, Tehran, Iran
| | - Ahmad Chitsaz
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Karami
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation. Transl Stroke Res 2016; 8:122-130. [PMID: 27212039 DOI: 10.1007/s12975-016-0471-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
Previous cross-sectional studies have demonstrated a higher incidence of dehydration in patients admitted for stroke suggesting a possible association. However, the temporality of the association has not been well established. We examined whether dehydration increases the risk of ischemic stroke in patients with a recent hospitalization for atrial fibrillation (AF). Data was from 1994 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records New Jersey hospitals, for AF hospitalizations (n = 1,282,787). Estimates for the association between AF hospitalization with/without dehydration and ischemic stroke within 30 days post-AF discharge were determined using log-linear multivariable modeling adjusting for socio-demographic factors and comorbid conditions. Within 10 days of discharge for AF, patients 18-80 years old (YO) with comorbid dehydration had a 60 % higher risk of ischemic stroke compared to AF patients without comorbid dehydration (adjusted risk ratio (ARR) 1.60, 95 % confidence interval (CI) 1.28-2.00). Eighteen- to 80-YO patients had a 34 % higher risk of ischemic stroke in days 11-20 post-AF discharge (ARR 1.34, 95 % CI 1.04, 1.74). There was no difference in the risk of stroke in 18-80-YO patients with or without prior dehydration during days 21-30 post-AF discharge. We also found no difference in the risk of ischemic stroke during any time period in patients over 80 YO. Dehydration may be a significant risk factor for ischemic stroke in patients 18-80 YO with AF.
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Vasant DH, Michou E, O'Leary N, Vail A, Mistry S, Hamdy S. Pharyngeal Electrical Stimulation in Dysphagia Poststroke: A Prospective, Randomized Single-Blinded Interventional Study. Neurorehabil Neural Repair 2016; 30:866-75. [PMID: 27053641 DOI: 10.1177/1545968316639129] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharyngeal electrical stimulation (PES) appears to promote cortical plasticity and swallowing recovery poststroke. Objective We aimed to assess clinical effectiveness with longer follow-up. Methods Dysphagic patients (n = 36; median = 71 years; 61% male) recruited from 3 trial centers within 6 weeks of stroke, received active or sham PES in a single-blinded randomized design via an intraluminal pharyngeal catheter (10 minutes, for 3days). The primary outcome measure was the Dysphagia Severity Rating (DSR) scale (<4, no-mild; ≥4, moderate-severe). Secondary outcomes included unsafe swallows on the Penetration-Aspiration Scale (PAS ≥ 3), times to hospital discharge, and nasogastric tube (NGT) removal. Data were analyzed using logistic regression. Odds/hazard ratios (ORs/HRs) >1 for DSR <4, hospital discharge, and NGT removal and OR <1 for PAS ≥3, indicated favorable outcomes for active PES. Results Two weeks post-active PES, 11/18 (61%) had DSR <4: OR (95% CI) = 2.5 (0.52, 14). Effects of active versus sham for secondary outcomes included the following: PAS ≥3 at 2 weeks, OR (95% CI) = 0.61 (0.27, 1.4); times to hospital discharge, 39 days versus 52 days, HR (95% CI) = 1.2 (0.55, 2.5); NGT removal 8 versus 14 days, HR (95% CI) = 2.0 (0.51, 7.9); and DSR <4 at 3 months, OR (95% CI) = 0.97 (0.13, 7.0). PES was well tolerated, without adverse effects or associations with serious complications (chest infections/death). Conclusions Although the direction of observed differences were consistent with PES accelerating swallowing recovery over the first 2 weeks postintervention, suboptimal recruitment prevents definitive conclusions. Our study design experience and outcome data are essential to inform a definitive, multicenter randomized trial.
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Affiliation(s)
- Dipesh H Vasant
- University of Manchester, Salford, UK Salford Royal Foundation Trust, Salford, UK
| | - Emilia Michou
- University of Manchester, Salford, UK Salford Royal Foundation Trust, Salford, UK
| | | | - Andy Vail
- University of Manchester, Salford, UK Salford Royal Foundation Trust, Salford, UK
| | - Satish Mistry
- University of Manchester, Salford, UK Salford Royal Foundation Trust, Salford, UK
| | - Shaheen Hamdy
- University of Manchester, Salford, UK Salford Royal Foundation Trust, Salford, UK
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Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, Havard D, McFarlane M, McLauglin C, Randall M, Robson K, Scutt P, Smith C, Smithard D, Sprigg N, Warusevitane A, Watkins C, Woodhouse L, Bath PM. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke 2016; 11:399-411. [PMID: 27006423 DOI: 10.1177/1747493016639057] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Abstract
Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.
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Affiliation(s)
| | - Christine Roffe
- Stroke Research, University Hospital of North Midlands, Keele University, UK
| | | | | | - Carol A Fairfield
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Shaheen Hamdy
- Institute of Inflammation and Repair, University of Manchester, UK
| | - Di Havard
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | | | | | - Katie Robson
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Craig Smith
- Stroke and Vascular Research Centre, University of Manchester, UK
| | - David Smithard
- Elderly Medicine, Princess Royal University Hospital, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Caroline Watkins
- College of Health and Wellbeing, University of Central Lancashire, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
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Andrade SM, Santos NA, Fernández-Calvo B, Boggio PS, Oliveira EA, Ferreira JJ, Sobreira A, Morgan F, Medeiros G, Cavalcanti GS, Gadelha ID, Duarte J, Marrocos J, Silva MA, Rufino T, Nóbrega SR. Stroke Treatment Associated with Rehabilitation Therapy and Transcranial DC Stimulation (START-tDCS): a study protocol for a randomized controlled trial. Trials 2016; 17:56. [PMID: 26822418 PMCID: PMC4731905 DOI: 10.1186/s13063-016-1186-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background Traditional treatment for motor impairment after stroke includes medication and physical rehabilitation. The transcranial direct current stimulation associated with a standard physical therapy program may be an effective therapeutic alternative for these patients. Methods This study is a sham-controlled, double-blind, randomized clinical trial aiming to evaluate the efficacy of transcranial direct current stimulation in activities of daily living and motor function post subacute stroke. In total there will be 40 patients enrolled, diagnosed with subacute, ischemic, unilateral, non-recurring stroke. Participants will be randomized to two groups, one with active stimulation and the other with a placebo current. Patients and investigators will be blinded. Everyone will receive systematic physical therapy, based on constraint-induced movement therapy. The intervention will be applied for 10 consecutive days. Patients will undergo three functional assessments: at baseline, week 2, and week 4. Neuropsychological tests will be performed at baseline and week 4. Adverse effects will be computed at each session. On completion of the baseline measures, randomization will be conducted using random permuted blocks. The randomization will be concealed until group allocation. Discussion This study will investigate the combined effects of transcranial direct current stimulation and physical therapy on functional improvement after stroke. We tested whether the combination of these treatments is more effective than physical therapy alone when administered in the early stages after stroke. Trial registration NCT02156635 - May 30, 2014. Randomization is ongoing (40 participants randomized as of the end of December 2015).
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Affiliation(s)
- Suellen M Andrade
- Cognitive Neuroscience and Behavior Program, Federal University of Paraíba, João Pessoa, Brazil.
| | - Natanael A Santos
- Perception, Neurosciences and Behavior Laboratory, Federal University of Paraíba, João Pessoa, Brazil.
| | | | - Paulo S Boggio
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil.
| | - Eliane A Oliveira
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - José J Ferreira
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Amanda Sobreira
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Felipe Morgan
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Germana Medeiros
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Gyovanna S Cavalcanti
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Ingrid D Gadelha
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Jader Duarte
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Joercia Marrocos
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Michele A Silva
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Thatiana Rufino
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Sanmy R Nóbrega
- Neuromuscular Adaptations Laboratory, Federal University of São Carlos, São Carlos, Brazil.
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Pisegna JM, Kaneoka A, Pearson WG, Kumar S, Langmore SE. Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials. Clin Neurophysiol 2016; 127:956-968. [PMID: 26070517 PMCID: PMC5326549 DOI: 10.1016/j.clinph.2015.04.069] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/19/2015] [Accepted: 04/25/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The primary aim of this review is to evaluate the effects of non-invasive brain stimulation on post-stroke dysphagia. METHODS Thirteen databases were systematically searched through July 2014. Studies had to meet pre-specified inclusion and exclusion criteria. Each study's methodological quality was examined. Effect sizes were calculated from extracted data and combined for an overall summary statistic. RESULTS Eight randomized controlled trials were included. These trials revealed a significant, moderate pooled effect size (0.55; 95% CI=0.17, 0.93; p=0.004). Studies stimulating the affected hemisphere had a combined effect size of 0.46 (95% CI=-0.18, 1.11; p=0.16); studies stimulating the unaffected hemisphere had a combined effect size of 0.65 (95% CI=0.14, 1.16; p=0.01). At long-term follow up, three studies demonstrated a large but non-significant pooled effect size (0.81, p=0.11). CONCLUSIONS This review found evidence for the efficacy of non-invasive brain stimulation on post-stroke dysphagia. A significant effect size resulted when stimulating the unaffected rather than the affected hemisphere. This finding is in agreement with previous studies implicating the plasticity of cortical neurons in the unaffected hemisphere. SIGNIFICANCE Non-invasive brain stimulation appears to assist cortical reorganization in post-stroke dysphagia but emerging factors highlight the need for more data.
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Affiliation(s)
- Jessica M Pisegna
- Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States.
| | - Asako Kaneoka
- Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States.
| | - William G Pearson
- Georgia Regents University, 1120 15th St., Augusta, GA 30912, United States.
| | - Sandeep Kumar
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States.
| | - Susan E Langmore
- Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States.
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Yang S, Choi KH, Son YR. The Effect of Stroke on Pharyngeal Laterality During Swallowing. Ann Rehabil Med 2015; 39:509-16. [PMID: 26361586 PMCID: PMC4564697 DOI: 10.5535/arm.2015.39.4.509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/12/2014] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate whether patterns of dysphagia and swallowing laterality differ according to the location of brain lesions in patients with stroke. Methods Patients with stroke >20 years of age were enrolled in this study. A videofluoroscopic swallowing study (VFSS) including the anterior-posterior view was used to assess swallowing. Patterns of swallowing were classified into three types according to the width of barium sulfate flow while passing the pharyngoesophageal segment: right-side-dominant flow, left-side-dominant flow, and no laterality in flow. Laterality was defined when the width of one side was twice or more the width of the other side. Results A total of 92 patients who underwent swallowing function evaluations by VFSS were enrolled from Sep-tember 2012 to May 2013. Of these, 72 patients had supratentorial lesions (group I) and 20 patients had infratento-rial lesions (group II). Only 10 patients (13.9%) in group I and three patients (15.0%) in group II showed laterality. Of these 13 patients, laterality occurred on the left side regardless of the side of the brain lesion. No relationships were found between swallowing laterality and location of stroke or motor weakness. Conclusion The results suggest that swallowing laterality was not prevalent among patients with stroke and that lesion side, location of the brain lesion, or motor weakness did not influence swallowing laterality. Although stroke can cause symptoms of dysphagia, it is difficult to conclude that stroke has a crucial impact on swallowing laterality.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Ri Son
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Michou E, Williams S, Vidyasagar R, Downey D, Mistry S, Edden RAE, Hamdy S. fMRI and MRS measures of neuroplasticity in the pharyngeal motor cortex. Neuroimage 2015; 117:1-10. [PMID: 25976926 DOI: 10.1016/j.neuroimage.2015.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Paired associative stimulation (PAS), is a novel non-invasive technique where two neural substrates are employed in a temporally coordinated manner in order to modulate cortico-motor excitability within the motor cortex (M1). In swallowing, combined pharyngeal electrical and transcranial-magnetic-stimulation induced beneficial neurophysiological and behavioural effects in healthy subjects and dysphagic stroke patients. Here, we aimed to investigate the whole-brain changes in neural activation during swallowing using functional magnetic resonance imaging (fMRI) following PAS application and in parallel assess associated GABA changes with magnetic resonance spectroscopy (MRS). METHODS Healthy adults (n=11, 38±9years old) were randomised to receive real and sham PAS to the 'stronger' motor cortex pharyngeal representation, on 2 separate visits. Following PAS, event-related fMRI was performed to assess changes in brain activation in response to water and saliva swallowing and during rest. Data were analysed (SPM8) at P<.001. MRS data were acquired using MEGA-PRESS before and after the fMRI acquisitions on both visits and GABA concentrations were measured (AMARES, jMRUI). RESULTS Following real PAS, BOLD signal changes (group analyses) increased at the site of stimulation during water and saliva swallowing, compared to sham PAS. It is also evident that PAS induced significant increases in BOLD signal to contralateral (to stimulation) hemispheric areas that are of importance to the swallowing neural network. Following real PAS, GABA:creatine ratio showed a trend to increase contralateral to PAS. CONCLUSION Targeted PAS applied to the human pharyngeal motor cortex induces local and remote changes in both primary and non-primary areas for water and saliva tasks. There is a possibility that changes of the inhibitory neurotransmitter, GABA, may play a role in the changes in BOLD signal. These findings provide evidence for the mechanisms underlying the beneficial effects of PAS on the brain swallowing network.
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Affiliation(s)
- Emilia Michou
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK.
| | - Steve Williams
- Centre for Imaging Science, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, M13 9PT, UK
| | - Rishma Vidyasagar
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Melbourne, Victoria, Australia; Department of Anatomy and Neuroscience, Melbourne University, Melbourne, Victoria, Australia
| | - Darragh Downey
- Neuroscience and Psychiatry Unit, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, M13 9PT, UK
| | - Satish Mistry
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK
| | - Richard A E Edden
- FM Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK
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Cheng IKY, Chan KMK, Wong CS, Cheung RTF. Preliminary evidence of the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing functions in post-stroke individuals with chronic dysphagia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:389-396. [PMID: 25588767 DOI: 10.1111/1460-6984.12144] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 09/26/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND There is growing evidence of potential benefits of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of dysphagia. However, the site and frequency of stimulation for optimal effects are not clear. AIMS The aim of this pilot study is to investigate the short-term effects of high-frequency 5 Hz rTMS applied to the tongue region of the motor cortex on swallowing functions and the quality of life of post-stroke individuals with dysphagia. METHODS & PROCEDURES Two male and two female participants were assigned randomly to active and sham groups. The participants in the active group received 10 sessions of active rTMS for 2 weeks, whereas the sham participants received 10 sessions of sham rTMS for 2 weeks. Each participant received a total of 3000 pulses of 5 Hz active or sham rTMS per day for 10 days. Outcome measures were taken at baseline, 1 week and 1 month post-rTMS. OUTCOMES & RESULTS Participants who received active rTMS had improved swallowing functions and swallowing-related quality of life at 1 week and 1 month post-stimulation. CONCLUSIONS & IMPLICATIONS The study showed that excitatory rTMS applied over the tongue motor cortex is a feasible approach in individuals with chronic post-stroke dysphagia. Further investigation with larger sample population is warranted to support the benefit of this stimulation protocol.
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Affiliation(s)
- Ivy K Y Cheng
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong, China
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Suntrup S, Teismann I, Wollbrink A, Winkels M, Warnecke T, Pantev C, Dziewas R. Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior - magnetoencephalographic evidence. Neuroimage 2014; 104:117-24. [PMID: 25451471 DOI: 10.1016/j.neuroimage.2014.10.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/15/2014] [Accepted: 10/06/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The act of swallowing is a complex neuromuscular function that is processed in a distributed network involving cortical, subcortical and brainstem structures. Difficulty in swallowing arises from a variety of neurologic diseases for which therapeutic options are currently limited. Pharyngeal electrical stimulation (PES) is a novel intervention designed to promote plastic changes in the pharyngeal motor cortex to aid dysphagia rehabilitation. In the present study we evaluate the effect of PES on cortical swallowing network activity and associated changes in swallowing performance. METHODS In a randomized, crossover study design 10min of real (0.2-ms pulses, 5Hz, 280V, stimulation intensity at 75% of maximum tolerated threshold) or sham PES were delivered to 14 healthy volunteers in two separate sessions. Stimulation was delivered via a pair of bipolar ring electrodes mounted on an intraluminal catheter positioned in the pharynx. Before and after each intervention swallowing capacity (ml/s) was tested using a 150ml-water swallowing stress test. Event-related desynchronization (ERD) of cortical oscillatory activity during volitional swallowing was recorded applying whole-head magnetoencephalography before, immediately after and 45min past the intervention. RESULTS A prominent reduction of ERD in sensorimotor brain areas occurred in the alpha and beta frequency ranges immediately after real PES but not after sham stimulation (p<0.05) and had faded after 45min. Volume per swallow and swallowing capacity significantly increased following real stimulation only. CONCLUSION Attenuation of ERD following PES reflects stimulation-induced increased swallowing processing efficiency, which is associated with subtle changes in swallowing function in healthy subjects. Our data contribute evidence that swallowing network organization and behavior can effectively be modulated by PES.
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Affiliation(s)
- Sonja Suntrup
- Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany.
| | - Inga Teismann
- Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Martin Winkels
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
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Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Can't swallow, can't transfer, can't toilet: factors predicting infections in the first week post stroke. J Clin Neurosci 2014; 22:92-7. [PMID: 25174763 DOI: 10.1016/j.jocn.2014.05.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 05/15/2014] [Indexed: 11/18/2022]
Abstract
Post stroke infections are a significant clinical problem. Dysphagia occurs in approximately half of stroke patients and is associated with respiratory infections; however it is unclear what other factors contribute to an increased risk. This study aimed to determine which factors are most strongly predictive of infections in the first 7 days post stroke admission. A retrospective review of 536 stroke patients admitted to Australian hospitals in 2010 was conducted. Data were collected on 37 clinical and demographic parameters. Univariate and multivariate logistic regression analysis was performed. The overall incidence of infection was 21%. Full assistance with mobility and incontinence on admission were associated with increased odds of general infection. Nil by mouth and presence of a nasogastric tube were significantly associated with patients developing respiratory infections. Urinary incontinence was a significant predictor for a urinary tract infection. Incidence of infection was highest on day two post admission. This study found enteral feeding, requiring full assistance with mobility and incontinence were significantly associated with developing infections in acute stroke. It contributes valuable new data from a large cohort of stroke patients demonstrating a period of susceptibility to infection in the very acute post stroke period.
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Affiliation(s)
- Emily Brogan
- Speech Pathology Department, Sir Charles Gairdner Hospital, 3rd Floor A Block, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Claire Langdon
- Western Australian Department of Health, East Perth, WA, Australia
| | - Kim Brookes
- Speech Pathology Department, Sir Charles Gairdner Hospital, 3rd Floor A Block, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Charley Budgeon
- Centre for Applied Statistics, University of Western Australia, Crawley, WA, Australia; Department of Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - David Blacker
- Neurology Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; The School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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Somasundaram S, Henke C, Neumann-Haefelin T, Isenmann S, Hattingen E, Lorenz MW, Singer OC. Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke. Cerebrovasc Dis 2014; 37:217-22. [DOI: 10.1159/000358118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
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Lee JH, Kim SB, Lee KW, Lee SJ, Park JG, Ri JW. Associating factors regarding nasogastric tube removal in patients with Dysphagia after stroke. Ann Rehabil Med 2014; 38:6-12. [PMID: 24639920 PMCID: PMC3953365 DOI: 10.5535/arm.2014.38.1.6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022] Open
Abstract
Objective To demonstrate associating factors regarding nasogastric tube (NGT) removal in patients with dysphagia after stroke. Methods This study is a retrospective medical chart review. Patients were divided into non-brain stem (NBS) and brain stem (BS) groups. A videofluoroscopic swallowing study was conducted until swallowing functions were recovered. Initial disease status was measured using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Risk factors related to stroke were evaluated. The penetration-aspiration scale (PAS) was used as the swallowing test. Functional status was measured by Mini-Mental Status Examination (MMSE) and Modified Barthel Index (MBI). Within each group, initial evaluations and their subsequent changes were compared according to the NGT removal status. Correlation between the NGT removal time and other initial factors were evaluated. Results Ninety-nine patients were allocated to the NBS group and 39 to the BS group. In NBS, age, PAS, MMSE, and MBI were significantly different according to the NGT removal status. In BS, smoking and PAS were significantly different. In NBS, changes in PAS, MMSE, and MBI were significantly different according to the NGT removal status. In BS, only PAS change was significantly different. In NBS, initial NIHSS, mRS, MMSE, and MBI were correlated with removal time. Conclusion In stroke patients with NTG, younger age, better initial disease and functional status seems to remove NGT in NBS stroke. Therefore, when deciding to remove NGT, those three factors should be considered discreetly.
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Affiliation(s)
- Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jae Won Ri
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
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Abstract
SummaryDysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are well-established practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.
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Vasant DH, Mistry S, Michou E, Jefferson S, Rothwell JC, Hamdy S. Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing. J Physiol 2013; 592:695-709. [PMID: 24247983 PMCID: PMC3934709 DOI: 10.1113/jphysiol.2013.263475] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The human cortical swallowing system exhibits bilateral but functionally asymmetric representation in health and disease as evidenced by both focal cortical inhibition (pre-conditioning with 1 Hz repetitive transcranial magnetic stimulation; rTMS) and unilateral stroke, where disruption of the stronger (dominant) pharyngeal projection alters swallowing neurophysiology and behaviour. Moreover, excitatory neurostimulation protocols capable of reversing the disruptive effects of focal cortical inhibition have demonstrated therapeutic promise in post-stroke dysphagia when applied contralaterally. In healthy participants (n = 15, 8 males, mean age (±SEM) 35 ± 9 years), optimal parameters of transcranial direct current stimulation (tDCS) (anodal, 1.5 mA, 10 min) were applied contralaterally after 1 Hz rTMS pre-conditioning to the strongest pharyngeal projection. Swallowing neurophysiology was assessed in both hemispheres by intraluminal recordings of pharyngeal motor-evoked responses (PMEPs) to single-pulse TMS as a measure of cortical excitability. Swallowing behaviour was examined using a pressure-based reaction time protocol. Measurements were made before and for up to 60 min post intervention. Subjects were randomised to active or sham tDCS after 1 Hz rTMS on separate days and data were compared using repeated measures ANOVA. Active tDCS increased PMEPs bilaterally (F1,14 = 7.4, P = 0.017) reversing the inhibitory effects of 1 Hz rTMS in the pre-conditioned hemisphere (F1,14 = 10.1, P = 0.007). Active tDCS also enhanced swallowing behaviour, increasing the number of correctly timed challenge swallows compared to sham (F1,14 = 6.3, P = 0.025). Thus, tDCS to the contralateral pharyngeal motor cortex reverses the neurophysiological and behavioural effects of focal cortical inhibition on swallowing in healthy individuals and has therapeutic potential for dysphagia rehabilitation.
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Affiliation(s)
- Dipesh H Vasant
- Gastrointestinal Centre, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Salford Royal NHS Foundation Trust, Salford M6 8HD, UK.
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