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The Hyoid Bone Kinematics in Dysphagic Stroke Patients: Instantaneous Velocity, Acceleration and Temporal Sequence Matters

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Abstract

Hyoid bone excursion (HBE) is one of the most critical events in the pharyngeal phase of swallowing. Most previous studies focused on the total displacement and average velocity of HBE. However, HBE during swallowing is not one-dimensional, and the change of velocity and acceleration is not linear. This study aims to elucidate the relationship between the instantaneous kinematics parameters of HBE and the severity of penetration/aspiration and pharyngeal residue in patients with stroke. A total of 132 sets of video-fluoroscopic swallowing study images collected from 72 dysphagic stroke patients were analyzed. The maximal instantaneous velocity, acceleration, displacement, and the time required to reach these values in the horizontal and vertical axes were measured. Patients were grouped according to the severity of the Penetration-Aspiration Scale and the Modified Barium Swallow Impairment Profile- Pharyngeal Residue. The outcome was then stratified according to the consistencies of swallowing materials. Stroke patients with aspiration were associated with a lower maximal horizontal instantaneous velocity and acceleration of HBE, a shorter horizontal displacement, and prolonged time to maximal vertical instantaneous velocity compared to the non-aspirators. In patients with pharyngeal residue, the maximal horizontal displacement of HBE was decreased. After stratification according to bolus consistencies, the temporal parameters of HBE were more significantly associated with aspiration severity when swallowing thin bolus. Meanwhile spatial parameters such as displacement had a bigger influence on aspiration severity when swallowing viscous bolus. These novel kinematic parameters of HBE could provide important reference for estimating swallowing function and outcomes in dysphagic stroke patients.

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Acknowledgements

The material was also provided to Yu-Chen Wang, MS, Jiun-Jen Yang, MD, and AetherAI Co., Ltd. for data collection and analysis while they are working for or collaborating with the Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital from May 1st, 2015, to May 1st, 2020.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St, Zhongzheng Dist, Taipei City, 100, Taiwan

    Shao-Yu Chen, Kuo-Chang Wei, Sheng-Hao Cheng, Tyng-Guey Wang & Ming-Yen Hsiao

  2. Department of Physical Medicine and Rehabilitation, Cathay General Hospital, 280 Renai Rd. Sec.4, Taipei City, 106, Taiwan

    Kuo-Chang Wei

  3. Department of Physical Medicine and Rehabilitation, National Taiwan University BioMedical Park Hospital Chu-Tung Campus, No. 52, Zhishan Rd, Zhudong Township, Hsinchu County, 310, Taiwan

    Sheng-Hao Cheng

  4. Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No.7, Zhongshan S. Rd, Zhongzheng Dist, Taipei City, 100, Taiwan

    Tyng-Guey Wang & Ming-Yen Hsiao

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Contributions

TGW, MD, MYH, MD, PhD, and SYC, MD: conceptualized the study. TGW, MD, MYH, MD, PhD: designed the methodology of the study. KCW, MD, SHC, MD, SYC, MD: analyzed the data. SYC, MD: drafted the manuscript. All authors reviewed and edited the manuscript and approved the final version.

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Correspondence to Ming-Yen Hsiao.

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Chen, SY., Wei, KC., Cheng, SH. et al. The Hyoid Bone Kinematics in Dysphagic Stroke Patients: Instantaneous Velocity, Acceleration and Temporal Sequence Matters. Dysphagia 38, 1598–1608 (2023). https://doi.org/10.1007/s00455-023-10587-w

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