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Matsuura D, Otaka Y, Asaumi S, Itano T, Chikamoto T, Yamori S, Murakami Y. Prediction of Oral Intake at Discharge with Early Assessment of Swallowing Function within 24 h after Admission: A Retrospective Cohort Study. Dysphagia 2024:10.1007/s00455-024-10699-x. [PMID: 38558178 DOI: 10.1007/s00455-024-10699-x] [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: 06/07/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24 h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.
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Affiliation(s)
- Daisuke Matsuura
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan.
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Saki Asaumi
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Tomomi Itano
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Tetsushi Chikamoto
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
- Department of Rehabilitation, Fukuyama rehabilitation hospital, Hiroshima, Japan
| | - Shigeru Yamori
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Yusuke Murakami
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
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Furtner J. Craniofacial musculature assessment: A novel technique for predicting stroke patient outcomes. Eur J Radiol 2023; 167:111024. [PMID: 37572561 DOI: 10.1016/j.ejrad.2023.111024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Affiliation(s)
- J Furtner
- Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Faculty of Medicine and Dentistry, Danube Private University, Rathausplatz 1, 3500 Krems, Austria.
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Yang SM, Wu HW, Lin YH, Lai TJ, Lin MT. Temporalis and masseter muscle thickness as predictors of post-stroke dysphagia after endovascular thrombectomy. Eur J Radiol 2023; 165:110939. [PMID: 37354770 DOI: 10.1016/j.ejrad.2023.110939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Post-stroke dysphagia (PSD) is a common sequela of stroke. Given the association between dysphagia and sarcopenia, we aimed to investigate the association between PSD and temporal muscle thickness (TMT) and masseter muscle thickness (MMT) following endovascular thrombectomy (EVT) in patients with large-vessel occlusion (LVO). METHODS This retrospective cohort study included hospitalized patients with LVO stroke who underwent EVT between January 1, 2018, and October 31, 2022. TMT and MMT were measured using brain computed tomography (CT) angiography. The correlation between relevant clinicodemographic factors and both TMT and MMT was examined. The relationship between each of two parameters (TMT and MMT) and PSD, which was defined as the retention of the nasogastric (NG) tube at 4 and 12 weeks, was evaluated in adjusted logistic regression models. RESULTS Among the 148 participants, the mean TMT and MMT was 5.9 ± 1.6 and 11.2 ± 2.3 mm, respectively. Lower age, male sex, higher body mass index (BMI), higher albumin levels, and a lower initial National Institute of Health Stroke Scale (NIHSS) score were associated with higher TMT and MMT (p < 0.05). In the logistic regression analysis adjusted for age, sex, BMI, serum albumin, and NIHSS score, lower TMT and MMT significantly correlated with PSD at weeks 4 and 12 (p < 0.001). CONCLUSION TMT and MMT are associated with age, sex, BMI, albumin, and the initial NIHSS score. Both TMT and MMT are independent indicators of post-EVT PSD in stroke patients and serve as reliable predictors of NG removal.
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Affiliation(s)
- Shu-Mei Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hao-Wei Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Ju Lai
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Wang L, Qiao J, Sun F, Wei X, Dou Z. Demographic and clinical factors associated with recovery of poststroke dysphagia: A meta-analysis. Brain Behav 2023; 13:e3033. [PMID: 37190927 PMCID: PMC10275539 DOI: 10.1002/brb3.3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Poststroke dysphagia (PSD) recovery depends on various factors. We aimed to provide evidence concerning predictive variables for the recovery of PSD. METHODS PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP database of Chinese periodicals, Chinese biomedical literature service system (SinoMed), and Cochrane Library databases were systematically searched up to September 21, 2022. According to the inclusion criteria, the literature searched in the database was screened. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed to identify the factors prognostic for PSD. RESULTS Twenty-eight studies were eligible, and pooled analyses were allowed for 12 potential prognostic factors. We identified older age, higher National Institutes of Health Stroke Scale (NIHSS) score, lower activities of daily living (ADL) score, lower body mass index (BMI), severe dysphagia on admission, aspiration, brainstem stroke, severe cognitive impairment, and bilateral hemispheric stroke were negative factors for the recovery of PSD, while early intervention and Modified Rankin Scale (mRS) = 0 before onset were protective factors for the recovery of PSD. There was no significant association between stroke type and prognosis of PSD. CONCLUSION Prognostic factors of PSD summarized in this meta-analysis could be useful for developing reasonable treatment plan to better promote recovery of swallowing function after stroke.
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Affiliation(s)
- Lian Wang
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jia Qiao
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Fang Sun
- Clinical Medical of Acupuncture Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouChina
| | - Xiaomei Wei
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zulin Dou
- Department of Rehabilitation MedicineThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Ikenaga Y, Fudeya M, Kusunoki T, Yamaguchi H. Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards. Prog Rehabil Med 2023; 8:20230011. [PMID: 37006382 PMCID: PMC10061229 DOI: 10.2490/prm.20230011] [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: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Methods: Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. Results: On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. Conclusions: The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | - Masami Fudeya
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
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Inooka Y, Yamana H, Shinoda Y, Inokuchi H, Matsui H, Fushimi K, Yasunaga H, Haga N. Predictive Factors for Oral Intake Recovery After Acute Stroke: Analysis of a Japanese Nationwide Inpatient Database. Dysphagia 2022; 37:1623-1632. [PMID: 35218414 DOI: 10.1007/s00455-022-10423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It remains unclear which factors contribute to dysphagia recovery after an acute stroke. This study aimed to identify factors associated with complete oral intake recovery in patients with post-stroke dysphagia. METHODS Data were obtained from the Diagnosis Procedure Combination database, which is a nationwide database of administrative claims and discharge abstracts in Japan. We selected patients admitted within 3 days of stroke onset and conducted multivariable logistic regression analysis. Total oral intake within 30 days of admission was the primary outcome measure. RESULTS A total of 151,302 patients were included, and total oral intake was observed in 48% of them within 30 days of admission. Total oral intake was significantly associated with age, sex, stroke subtype, consciousness disturbance, low body mass index, multiple comorbidities, and the modified Rankin Scale before stroke onset. In addition, males had worse outcomes than females (odds ratio, 0.75; 95% confidence interval, 0.73-0.77, p < 0.001), and intracerebral and subarachnoid hemorrhagic stroke subtypes were associated with non-recovery. CONCLUSION This study identified several prognostic factors for total oral intake in patients with acute stroke. These results may be useful for predicting a patient's dysphagia prognosis at the time of admission and designing a nutritional management plan for patients with acute stroke.
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Affiliation(s)
- Yasuhiro Inooka
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Rehabilitation, Yoyogi Hospital, 1-30-7 Sendagaya, Shibuya-ku, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, Japan.
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Iruma-Gun, Saitama, 350-0495, Japan.
| | - Haruhi Inokuchi
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Brandão BC, Silva MAOMD, Rodrigues CG, Damando MD, Lourenção LG. Relationship between oral intake and severity of Acute Stroke. Codas 2020; 32:e20180154. [PMID: 33053079 DOI: 10.1590/2317-1782/20202018154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/22/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To correlate stroke severity with oral intake level of the studied population and compare the two factors at the time of admission and after swallowing management. METHODS A total of 137 patients hospitalized in the cerebral vascular accident unit (CVAU) of a teaching hospital participated. During the stay at CVAU, the patients were submitted to daily neurological evaluation and application of National Institutes of Health Stroke Scale (NIHSS), to evaluate the severity of stroke, ranging from zero (without evidence of neurological deficit) to 42 (in coma and unresponsive). Functional Oral Intake Scale (FOIS), which is a marker for evolution of oral intake and ranges from level one (nothing oral) to seven (oral total restrictions). Data from the NIHSS and FOIS scales of admission and discharge were analyzed and compared to verify association between improvement of oropharyngeal dysphagia with functional improvement of individuals. RESULTS At admission, 63 (46.0%) patients had mild strokes, 38 (27.7%) had severe and very severe stroke; 46 (33.6%) had oral intake and need for special preparation or compensations. At discharge, there was an increase in patients with mild stroke (76 - 55.5%); oral intake without special preparation or compensations, but with food restrictions (18 - 13.1%), and oral intake without restrictions (44 - 32.1%). CONCLUSION The level of oral intake increased as the severity of stroke decreased. Speech and language therapy contributed to a decrease in stroke severity and improvement in oral intake.
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Affiliation(s)
| | | | | | - Marina Dipe Damando
- Faculdade de Medicina de São José do Rio Preto - FAMERP - São José do Rio Preto (SP), Brasil
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Ikenaga Y, Nakayama S, Taniguchi H, Ohori I, Komatsu N, Nishimura H, Katsuki Y. Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward. J Stroke Cerebrovasc Dis 2017; 26:1013-1019. [PMID: 28108097 DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. METHOD Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. RESULTS Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. CONCLUSIONS Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan.
| | - Sayaka Nakayama
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hiroki Taniguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Isao Ohori
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Nahoko Komatsu
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hitoshi Nishimura
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Yasuo Katsuki
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
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Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, de Arruda Henry MAC, Bazan R. Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2088-94. [PMID: 26187787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/23/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. METHODS This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. RESULTS The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. CONCLUSIONS There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.
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Affiliation(s)
- Priscila W Ribeiro
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - Paula C Cola
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Ana R Gatto
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Roberta G da Silva
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Gustavo J Luvizutto
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gabriel P Braga
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Arthur O Schelp
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Maria A C de Arruda Henry
- Department of Surgery, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Rodrigo Bazan
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
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Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M. Predictive factors for oral intake after aspiration pneumonia in older adults. Geriatr Gerontol Int 2015; 16:556-60. [DOI: 10.1111/ggi.12506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ryo Momosaki
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research; Clinical Research Center, National Hospital Organization Headquarters; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo Japan
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Factors Associated with Prognosis of Eating and Swallowing Disability after Stroke: A Study from a Community-based Stroke Care System. J Stroke Cerebrovasc Dis 2013; 22:926-930.e1. [PMID: 23680686 DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/31/2013] [Accepted: 04/06/2013] [Indexed: 11/23/2022] Open
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Nakajima M, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T. Acquisition of oral intake in severely dysphagic patients with acute stroke: A single-center, observational study involving a database of 4972 consecutive stroke patients. J Neurol Sci 2012; 323:56-60. [DOI: 10.1016/j.jns.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/01/2012] [Accepted: 08/08/2012] [Indexed: 11/28/2022]
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