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Dysphagia

, Volume 24, Issue 3, pp 257–264 | Cite as

Predicting Aspiration After Hemispheric Stroke from Timing Measures of Oropharyngeal Bolus Flow and Laryngeal Closure

  • Maxine L. PowerEmail author
  • Shaheen Hamdy
  • John Y. Goulermas
  • Pippa J. Tyrrell
  • Ian Turnbull
  • David G. Thompson
Original Article

Abstract

Deglutitive aspiration is common after stroke, affecting up to 50% of patients and predisposing them to pneumonia, yet it is virtually impossible to predict those patients at greatest risk. The aim of this study was to develop a robust predictive model for aspiration after stroke. Swallowing was assessed by digital videofluoroscopy (VF) in 90 patients following hemispheric stroke. Lesion characteristics were determined by computerized tomography (CT) brain scan using the Alberta Stroke Programme Early CT Score (ASPECTS). Aspiration severity was measured using a validated penetration-aspiration scale. The probability of aspiration was then determined from measures of swallowing pathophysiology and lesion location by discriminant analysis. Aspiration was observed in 47 (52%) patients, yet despite disrupted swallowing physiology, intrasubject aspiration scores were variable. The best discriminant model combined pharyngeal transit time, swallow response time, and laryngeal closure duration to predict 73.11% of those aspirating (sensitivity = 66.54, specificity = 80.22, p > 0.001). The addition of lesion location did not add anything further to the predictive model. We conclude that the pathophysiology of poststroke aspiration is multifactorial but in most cases can be predicted by three key swallowing measurements. These measurements, if translatable into clinical bedside evaluation, may assist with the development of novel measurement and intervention techniques to detect and treat poststroke aspiration.

Keywords

Aspiration Computerized tomography Deglutition Dysphagia Lesion location Videofluoroscopy Deglutition disorders 

Notes

Acknowledgments

The authors thank Ms. L. Renaut (Radiography, Salford Royal Hospital) and Dr A. Vail (Statistician, University of Manchester) for their invaluable assistance.

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Maxine L. Power
    • 1
    • 2
    Email author
  • Shaheen Hamdy
    • 3
  • John Y. Goulermas
    • 4
  • Pippa J. Tyrrell
    • 2
  • Ian Turnbull
    • 5
  • David G. Thompson
    • 3
  1. 1.Department of Rehabilitation and Human Performance ResearchUniversity of SalfordSalfordUK
  2. 2.Department of Stroke MedicineUniversity of Manchester SalfordUK
  3. 3.Department of Gastrointestinal SciencesUniversity of Manchester SalfordUK
  4. 4.Department of Electrical Engineering and ElectronicsUniversity of LiverpoolLiverpoolUK
  5. 5.Department of RadiologyUniversity of Manchester SalfordUK

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