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Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia

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Abstract

The purpose of this study was to investigate swallowing kinematics and explore kinematic factors related with penetration-aspiration in patients with post-stroke dysphagia. Videofluoroscopic images of 68 patients with post-stroke dysphagia and 34 sex- and age-matched healthy controls swallowing a thin liquid were quantitatively analyzed using two-dimensional motion digitization. The measurements included the movement distances and velocities of the hyoid and larynx, and the maximal tilt angles and angular velocities of the epiglottis. All velocity variables were significantly decreased in the stroke patients compared to the controls. There was a significant difference in the maximal horizontal displacement of the larynx, but there were no significant differences in other displacements of the larynx, the maximal displacements of the hyoid bone, and the maximum tilt angle of the epiglottis between the two groups. The maximal tilt angle of the epiglottis was lower in the aspiration subgroup than in the no penetration/aspiration and penetration subgroups as well as the controls. The maximal tilt angle from the y axis showed a dichotomous pattern at 90° of the angle, and all 11 patients with an angle <90° showed either penetration or aspiration. In the ROC curve of the angle for prediction of aspiration, the area under the curve was 0.725 (95 % CI 0.557–0.892, P = 0.008). This study suggested that sluggish rather than decreased hyolaryngeal movements during swallowing are a remarkable feature of post-stroke dysphagia. The association of reduced epiglottic movement with the risk of aspiration in patients with post-stroke dysphagia was supported by the quantitative analysis.

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References

  1. Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001;16:7–18.

    Article  CAS  PubMed  Google Scholar 

  2. Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol. 1994;51:1051–3.

    Article  CAS  PubMed  Google Scholar 

  3. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J. 2006;82:383–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Steele CM, Cichero JA. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29:295–304.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Molfenter SM, Steele CM. Kinematic and temporal factors associated with penetration-aspiration in swallowing liquids. Dysphagia. 2014;29:269–76.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Paik NJ, Kim SJ, Lee HJ, Jeon JY, Lim JY, Han TR. Movement of the hyoid bone and the epiglottis during swallowing in patients with dysphagia from different etiologies. J Electromyogr Kinesiol. 2008;18:329–35.

    Article  PubMed  Google Scholar 

  7. Kim Y, McCullough GH. Maximal hyoid excursion in poststroke patients. Dysphagia. 2010;25:20–5.

    Article  PubMed  Google Scholar 

  8. Bingjie L, Tong Z, Xinting S, Jianmin X, Guijun J. Quantitative videofluoroscopic analysis of penetration-aspiration in post-stroke patients. Neurol India. 2010;58:42–7.

    Article  PubMed  Google Scholar 

  9. Kahrilas PJ, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113:1457–64.

    Article  CAS  PubMed  Google Scholar 

  10. Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78:141–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kim Y, McCullough GH. Stage transition duration in patients poststroke. Dysphagia. 2007;22:299–305.

    Article  PubMed  Google Scholar 

  12. Power ML, Hamdy S, Goulermas JY, Tyrrell PJ, Turnbull I, Thompson DG. Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure. Dysphagia. 2009;24:257–64.

    Article  PubMed  Google Scholar 

  13. Park T, Kim Y, Ko DH, McCullough G. Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients. Dysphagia. 2010;25:177–82.

    Article  PubMed  Google Scholar 

  14. Oommen ER, Kim Y, McCullough G. Stage transition and laryngeal closure in poststroke patients with dysphagia. Dysphagia. 2011;26:318–23.

    Article  PubMed  Google Scholar 

  15. Seo HG, Oh BM, Han TR. Longitudinal changes of the swallowing process in subacute stroke patients with aspiration. Dysphagia. 2011;26:41–8.

    Article  PubMed  Google Scholar 

  16. Nagy A, Molfenter SM, Peladeau-Pigeon M, Stokely S, Steele CM. The effect of bolus consistency on hyoid velocity in healthy swallowing. Dysphagia. 2015;30:445–51.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19:691–707.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-ed; 1998.

    Google Scholar 

  19. Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23:59–64.

    Article  PubMed  Google Scholar 

  20. American Speech-Language-Hearing Association. National outcomes measurement system (NOMS): adult speech-language pathology user’s guide. Rockville: American Speech-Language-Hearing Association; 2003.

    Google Scholar 

  21. Lee SH, Oh BM, Chun SM, Lee JC, Min Y, Bang SH, Kim HC, Han TR. The accuracy of the swallowing kinematic analysis at various movement velocities of the hyoid and epiglottis. Ann Rehabil Med. 2013;37:320–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ekberg O, Sigurjonsson SV. Movement of the epiglottis during deglutition. A cineradiographic study. Gastrointest Radiol. 1982;7:101–7.

    Article  CAS  PubMed  Google Scholar 

  23. Vandaele DJ, Perlman AL, Cassell MD. Intrinsic fibre architecture and attachments of the human epiglottis and their contributions to the mechanism of deglutition. J Anat. 1995;186(Pt 1):1–15.

    PubMed  PubMed Central  Google Scholar 

  24. Curtis DJ, Cruess DF, Dachman AH, Maso E. Timing in the normal pharyngeal swallow. Prospective selection and evaluation of 16 normal asymptomatic patients. Invest Radiol. 1984;19:523–9.

    Article  CAS  PubMed  Google Scholar 

  25. Fink BR, Martin RW, Rohrmann CA. Biomechanics of the human epiglottis. Acta Otolaryngol. 1979;87:554–9.

    Article  CAS  PubMed  Google Scholar 

  26. Garon BR, Huang Z, Hommeyer M, Eckmann D, Stern GA, Ormiston C. Epiglottic dysfunction: abnormal epiglottic movement patterns. Dysphagia. 2002;17:57–68.

    Article  PubMed  Google Scholar 

  27. Steele CM, Bailey GL, Chau T, Molfenter SM, Oshalla M, Waito AA, Zoratto DC. The relationship between hyoid and laryngeal displacement and swallowing impairment. Clin Otolaryngol. 2011;36:30–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Molfenter SM, Steele CM. Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing. J Speech Lang Hear Res. 2014;57:768–78.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ishida R, Palmer JB, Hiiemae KM. Hyoid motion during swallowing: factors affecting forward and upward displacement. Dysphagia. 2002;17:262–72.

    Article  PubMed  Google Scholar 

  30. Paolucci S, Antonucci G, Grasso MG, Bragoni M, Coiro P, De Angelis D, Fusco FR, Morelli D, Venturiero V, Troisi E, Pratesi L. Functional outcome of ischemic and hemorrhagic stroke patients after inpatient rehabilitation: a matched comparison. Stroke. 2003;34:2861–5.

    Article  PubMed  Google Scholar 

  31. Kelly PJ, Furie KL, Shafqat S, Rallis N, Chang Y, Stein J. Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. Arch Phys Med Rehabil. 2003;84:968–72.

    Article  PubMed  Google Scholar 

  32. Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, Ozeki Y, Kanamori D, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26:209–17.

    Article  PubMed  Google Scholar 

  33. Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66:452–8.

    Article  PubMed  Google Scholar 

  34. Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011;26:225–31.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cvejic L, Harding R, Churchward T, Turton A, Finlay P, Massey D, Bardin PG, Guy P. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology. 2011;16:269–75.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea

    Han Gil Seo & Byung-Mo Oh

  2. Department of Rehabilitation Medicine, Gangwon Do Rehabilitation Hospital, 24-16, Chungyeol-ro 142beon-gil, Chuncheon-si, Gangwon-do, 200-939, Republic of Korea

    Tai Ryoon Han

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  1. Han Gil Seo
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Correspondence to Byung-Mo Oh.

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Seo, H.G., Oh, BM. & Han, T.R. Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia. Dysphagia 31, 160–168 (2016). https://doi.org/10.1007/s00455-015-9670-x

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