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Myung JH, Pyun SB. Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke. Dysphagia 2023; 38:227-235. [PMID: 35508738 DOI: 10.1007/s00455-022-10458-w] [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: 09/03/2021] [Accepted: 04/18/2022] [Indexed: 01/27/2023]
Abstract
Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.
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Affiliation(s)
- Jei Hak Myung
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sung-Bom Pyun
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea.
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.
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Kim D, Kim JH, Park SW, Han HW, An SJ, Kim YI, Ju HJ, Choi Y, Kim DY. Predictive value of the videofluoroscopic swallowing study for long-term mortality in patients with subacute stroke. Medicine (Baltimore) 2022; 101:e28623. [PMID: 35089200 PMCID: PMC8797482 DOI: 10.1097/md.0000000000028623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the usefulness of the videofluoroscopic swallowing study (VFSS) for subacute stroke in predicting long-term all-cause mortality, including not only simple parameters obtained from VFSS results, but also recommended dietary type as an integrated parameter.This was a retrospective study of patients with subacute (<1 month) stroke at a university hospital between February 2014 and September 2019. The independent risk factors were investigated using stepwise Cox regression analysis, which increased the all-cause mortality of patients with stroke among VFSS parameters.A total of 242 patients with subacute stroke were enrolled. The significant mortality-associated factors were age, history of cancer, recommended dietary type (modified dysphagia diet; adjusted hazard ratio [HR], 6.971; P = .014; tube diet, adjusted HR: 10.169; P = .019), and Modified Barthel Index. In the subgroup survival analysis of the modified dysphagia diet group (n = 173), the parameters for fluid penetration (adjusted HR: 1.911; 95% confidence interval, 1.086-3.363; P = .025) and fluid aspiration (adjusted HR: 2.236; 95% confidence interval, 1.274-3.927; P = .005) were significantly associated with mortality.The recommended dietary type determined after VFSS in subacute stroke was a significant risk factor for all-cause mortality as an integrated parameter for dysphagia. Among the VFSS parameters, fluid penetration and aspiration were important risk factors for all-cause mortality in patients with moderate dysphagia after stroke. Therefore, it is important to classify the degree of dysphagia by performing the VFSS test in the subacute period of stroke and to determine the appropriate diet and rehabilitation intervention for mortality-related prognosis.
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Affiliation(s)
- Daham Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Jae-Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Hyung-Wook Han
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Sang Joon An
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Yeong In Kim
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Hyo Jin Ju
- Department of Medical Humanities, College of Medicine, Catholic Kwandong University, Gangwon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - YoonHee Choi
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
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Mixed Consistencies in Dysphagic Patients: A Myth to Dispel. Dysphagia 2021; 37:116-124. [PMID: 33598791 PMCID: PMC8844162 DOI: 10.1007/s00455-021-10255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/27/2021] [Indexed: 11/03/2022]
Abstract
Only limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.
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Suitability of food in a rehabilitation hospital for patients with neurologic dysphagia. Int J Rehabil Res 2020; 43:276-279. [PMID: 32221148 DOI: 10.1097/mrr.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Texture-modified food is a common strategy in dysphagia management for increasing safety of swallowing. It is essential for the patient to receive the prescribed diet based on clinical and instrumental examination of swallowing in order to be able to benefit from rehabilitation and avoid complications. Variations in terminology and definitions regarding texture-modified food and liquids demonstrate the need for international standardized terminology. We aimed to assess suitability of texture-modified diets used at a rehabilitation hospital in terms of the International Dysphagia Diet Standardization Initiative guidelines. A texture-modified main dish was analyzed for 5 days (15 samples of pureed and 10 samples of minced texture) at lunch time by 2 trained assessors using International Dysphagia Diet Standardization Initiative-recommended testing methods. The majority of pureed and minced food samples did not suit the comparable International Dysphagia Diet Standardization Initiative levels. The results underline the need for implementing the International Dysphagia Diet Standardization Initiative guidelines in order to provide an appropriate texture-modified diet for patients with neurogenic dysphagia and support dysphagia management within inpatient rehabilitation.
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Cullins MJ, Connor NP. Reduced tongue force and functional swallowing changes in a rat model of post stroke dysphagia. Brain Res 2019; 1717:160-166. [PMID: 31022397 DOI: 10.1016/j.brainres.2019.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Dysphagia is a common problem after stroke that is often associated with tongue weakness. However, the physiological mechanisms of post-stroke tongue muscle weakness and optimal treatments have not been established. To advance understanding of physiological mechanisms of post stroke dysphagia, we sought to validate the unilateral transient middle cerebral artery occlusion (MCAO) rat model of ischemic stroke as a translational model of post stroke dysphagia. Our goal was to establish clinically relevant measures and chronicity of functional deficits; criteria that increase the likelihood that findings will translate to the clinic. We hypothesized that MCAO would cause tongue weakness and functional swallowing changes. METHODS Maximum voluntary tongue forces and videofluoroscopic swallowing studies were collected in 8-week old male Sprague-Dawley rats prior to receiving either a left MCAO (N = 10) or sham (N = 10) surgery. Tongue forces and VFSS were reassessed at 1 and 8 weeks post-surgery. RESULTS Maximum voluntary tongue force, bolus area, and bolus speed were significantly reduced in the MCAO group at the 1 and 8-week timepoints. CONCLUSION Clinically relevant changes to swallowing and tongue force support the use of the MCAO rat model as a translational model of post stroke dysphagia. This model will allow for future studies to improve our understanding of the physiology contributing to these functional changes as well as the impact of therapeutic interventions on physiological targets and function.
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Affiliation(s)
- Miranda J Cullins
- Department of Surgery, University of Wisconsin-Madison, United States.
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin-Madison, United States
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Nishimura S, Tanaka T, Oda M, Habu M, Kodama M, Yoshiga D, Osawa K, Kokuryo S, Miyamoto I, Kito S, Wakasugi-Sato N, Matsumoto-Takeda S, Joujima T, Miyamura Y, Hitomi S, Yamamoto N, Uehara M, Sasaguri M, Ono K, Yoshioka I, Tominaga K, Morimoto Y. Functional evaluation of swallowing in patients with tongue cancer before and after surgery using high-speed continuous magnetic resonance imaging based on T2-weighted sequences. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:88-98. [PMID: 29128287 DOI: 10.1016/j.oooo.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/21/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine the usefulness of evaluating the function of swallowing before and after surgery in patients with tongue cancer by using T2-weighted sequences of high-speed continuous magnetic resonance imaging (HSCMRI). STUDY DESIGN The imaging findings and related parameters on HSCMRI along with those on routine MRI examinations before and after surgery were examined in 19 patients with tongue cancer. In addition, changes in various parameters during 1 year after surgery were evaluated in 10 patients. RESULTS In most patients examined, the direction of flow to the esophagus could be seen on HSCMRI before and after surgery. Significant correlations were observed among 4 parameters and in the responses to a dysphagia questionnaire. CONCLUSIONS The results of the present study suggest that the dynamics of swallowing can be directly visualized on HSCMRI by using 4 parameters that permit the evaluation of changes before and after surgery, and this enables objective evaluation of patients' swallowing complaints.
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Affiliation(s)
- Shun Nishimura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Tatsurou Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Kodama
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Daigo Yoshiga
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Kenji Osawa
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Shinya Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuya Miyamoto
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Shinji Kito
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | | | - Takaaki Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Yuichi Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, Kitakyushu, Japan
| | - Noriaki Yamamoto
- Department of Dentistry and Oral-Maxillo-Facial Surgery, Oita University, Oita, Japan
| | - Masataka Uehara
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, Kitakyushu, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Kazuhiro Tominaga
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan; Center for Oral Biological Research, Kyushu Dental University, Kitakyushu, Japan.
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The Therapeutic Swallowing Study. Dysphagia 2017. [DOI: 10.1007/174_2017_89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pauloski BR, Nasir SM. Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time. Physiol Rep 2016; 4:4/11/e12752. [PMID: 27302989 PMCID: PMC4908483 DOI: 10.14814/phy2.12752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 01/17/2023] Open
Abstract
Pharyngeal delay is a significant swallowing disorder often resulting in aspiration. It is suspected that pharyngeal delay originates from sensory impairment, but a direct demonstration of a link between oral sensation and pharyngeal delay is lacking. In this study involving six patients with complaints of dysphagia, taste sensation of the oral tongue was measured and subsequently related to swallowing kinematics. It was found that a response bias for sour taste was significantly correlated with pharyngeal delay time on paste, highlighting oral sensory contributions to swallow motor dysfunctions. Investigating the precise nature of such a link between oral sensation and dysphagia would constitute a basis for understanding the disorder. The results of this study highlight oral sensory contributions to pharyngeal swallow events and provide impetus to examine this link in larger samples of dysphagic patients.
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Affiliation(s)
- Barbara R Pauloski
- Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Wisconsin
| | - Sazzad M Nasir
- Department of Communication Sciences and Disorders, Northwestern University, Illinois
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Gaspar MDRDF, Pinto GDS, Gomes RHS, Santos RS, Leonor VD. Avaliação da qualidade de vida em pacientes com disfagia neurogênica. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517619114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: avaliar a qualidade de vida de pacientes com Acidente Vascular Encefálico e disfagia neurogênica. Métodos: estudo quantitativo, do tipo transversal, descritivo, realizado no Setor de Neurologia de um Hospital de Ensino, em Curitiba- Paraná. A amostra foi constituída de 35 indivíduos com Acidente Vascular Encefálico e queixa de disfagia. Os dados foram coletados por meio de questionário para avaliação da qualidade de vida em disfagia. Resultados: nas variáveis sociodemográficas houve predomínio de homens, idosos, brancos, casados e primeiro grau incompleto. A avaliação de qualidade de vida demonstrou que os domínios que apresentaram alterações foram os que investigam como a alteração da deglutição tem afetado o aspecto social dos participantes. A correlação de Mann-Whitney evidenciou significância estatística (p < 5) quando relacionou a deglutição como um fardo com o tempo de se alimentar (p 0,002), frequência dos sintomas (p <0,001), saúde mental (p <0,001) e fadiga (p <0,001). Conclusão: o levantamento estatístico comprovou o impacto causado pela disfagia neurogênica na qualidade de vida dos pacientes acometidos por Acidente Vascular Encefálico, representado pelas alterações encontradas nos resultados de avalição da qualidade de vida. Na correlação de Mann-Whitney, ao se realizar os cruzamentos entre os domínios do instrumento, os dados evidenciaram significância estatística quanto ao tempo de alimentação, medo de se alimentar, saúde mental, social e fadiga, que causam prejuízo na qualidade de vida dos pacientes com disfagia neurogênica.
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Swallowing Tablets and Capsules Increases the Risk of Penetration and Aspiration in Patients with Stroke-Induced Dysphagia. Dysphagia 2015. [DOI: 10.1007/s00455-015-9639-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang S, Olthoff A, Frahm J. Real-time magnetic resonance imaging of normal swallowing. J Magn Reson Imaging 2012; 35:1372-9. [PMID: 22271426 DOI: 10.1002/jmri.23591] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 01/03/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the use of a novel real-time magnetic resonance imaging (MRI) technique for the assessment of normal swallowing dynamics. MATERIALS AND METHODS In a cohort of 10 healthy subjects, real-time MRI movies at 24.3 frames per second were obtained in sagittal, coronal, and axial orientation during self-controlled swallows of 5 mL pineapple juice as oral contrast bolus. All studies were performed with the use of a commercial MRI system at 3 T combining two sets of radiofrequency receiver coils. Real-time movies relied on a fast low-angle shot (FLASH) MRI sequence with radial undersampling and image reconstruction by nonlinear inversion yielding 41.23 msec acquisition time for an in-plane resolution of 1.5 mm. Evaluations focused on clinical image quality as well as visualization and temporal quantification of distinct swallowing functions. RESULTS Throughout the entire process, the swallowing dynamics were well depicted and characterized with almost no visible image artifacts in all subjects. The mid-sagittal plane turned out to be most valuable. The movies allowed for a quantitative determination of the temporal pattern of all swallowing events. CONCLUSION The proposed real-time MRI technique yields noninvasive, robust, and quantitative access to the physiology of normal swallowing in healthy subjects at high temporal resolution and image quality.
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Affiliation(s)
- Shuo Zhang
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
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