Swallowing Outcomes In Patients With Subcortical Stroke Associated With Lesions Of The Caudate Nucleus And Insula

Objective: The present study was performed to investigate the relationships between swallowing outcomes and lesion location, bolus characteristics, and age in patients with subcortical stroke. Patients: Patients with subcortical and insular stroke (mean age, 57.38 ± 12.71 years) were investigated. All patients (n = 21) completed both brain magnetic resonance imaging studies and videofluoroscopic swallowing studies. Main Outcome Measures: The oral transit duration, pharyngeal transit duration (PTD), laryngeal response duration, and Penetration-Aspiration Scale (PAS) score were applied to examine the efficiency of propulsion and airway protection in three swallowing tasks. Path analyses were performed to assess the relationships between swallowing outcomes and lesion location, age, bolus viscosity, and bolus volume. Results: Caudate nucleus (CN) lesions were associated with higher PAS scores. Insular lesions were associated with a longer PTD. Advanced age was associated with a longer PTD. Bolus viscosity significantly moderated the association between CN lesions and higher PAS scores. Conclusions: In the present cohort, CN lesions impacted airway protection and insular lesions impacted pharyngeal transit. An increased bolus viscosity reduced the aspiration severity. These results suggest that lesion location is an important indicator to predict subsequent dysphagia in patients with subcortical stroke

Relationship Between Temporal Measurements Of Pharyngeal Swallowing And Penetration-Aspiration In Unilateral Stroke Patients

Objectives: Although few study have attempted to identify temporal measurements of swallowing in unilateral stroke patients, the relationship between temporal measurements and aspiration-related swallowing dysfunction remain unknown. The aim of this study was to investigate the relationship between temporal measurements of pharyngeal swallowing and aspiration in unilateral stroke patients. Methods: We conducted a prospective study of 60 patients undergoing both videofluoroscopic swallowing examinations and brain magnetic resonance imaging scan studies. Patients were divided into two groups: group 1 included subacute stroke patients with left cerebral hemispheric lesions (N=27) and group 2 included subacute stroke patients with right cerebral hemispheric lesions (N=33). The results of temporal measurements of swallowing, including pharyngeal transit duration (PTD), initiation laryngeal closure (ILC), and laryngeal closure duration (LCD) and penetration-aspiration, were analyzed during 5-mL thin liquids swallowing task. To determine the optimum cut-off value along with the presence of penetration-aspiration, receiver operating characteristic (ROC) curve analysis was performed. Results: The right cerebral hemispheric lesion group showed significant association with delayed PTD and ILC. The cut-off values for PTD and ILC were 0. 71 seconds (p=.02) and 1.25 seconds (p=.008), respectively. Conclusion: ILC is the most valid predictor for penetration-aspiration occurrence in stroke patients with right cerebral hemispheric lesions. Penetration-aspiration events on swallows are affected by delayed laryngeal closure and pharyngeal transit duration

Dysphagia And Oral Morbidities In Chemoradiation-Treated Head And Neck Cancer Patients

This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients