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Initiation and Duration of Laryngeal Closure During the Pharyngeal Swallow in Post-Stroke Patients

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Abstract

As a bolus enters the pharynx during the swallow, the airway is protected by laryngeal closure, a process characterized by approximation of the vocal folds plus approximation of the arytenoid cartilages to the base of the epiglottis. The purpose of this study was to measure initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in three groups of subjects: (1) ten stroke patients who aspirated before and during the swallow (aspirators), (2) ten stroke patients who did not aspirate (nonaspirators), and (3) ten normal control subjects. Means and standard deviations of ILC and LCD were analyzed for both 5-ml and 10-ml thin-liquid boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations. There were significant differences between aspirators and control subjects for both ILC and LCD, and significant differences between aspirators and nonaspirators for ILC. There were no significant differences between aspirators and nonaspirators for LCD. Both delayed ILC and reduced LCD were associated with post-stroke aspiration. Delayed ILC is a significant indicator of overall risk of aspiration. Clinical implications for these findings are discussed.

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References

  1. Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, et al. Closure mechanisms of laryngeal vestibule during swallowing. Am J Physiol Gastrointest Liver Physiol. 1992;262(2 Pt 1):G338–44.

    CAS  Google Scholar 

  2. Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed). 1987;295(6595):411–4.

    Article  CAS  Google Scholar 

  3. Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia. 1969;4:90–4. doi:10.1007/BF02407151.

    Article  Google Scholar 

  4. Robbins JA, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology. 1992;103:823–9.

    CAS  PubMed  Google Scholar 

  5. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43(5):1264–74.

    CAS  PubMed  Google Scholar 

  6. Logemann JA, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45(3):434–45. doi:10.1044/1092-4388(2002/034).

    Article  PubMed  Google Scholar 

  7. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;10:744–8.

    Google Scholar 

  8. Robbins J, Levine RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988;3:11–7. doi:10.1007/BF02406275.

    Article  CAS  PubMed  Google Scholar 

  9. Robbins J, Levine RL, Maser A, Rosenbek JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993;74:1295–300. doi:10.1016/0003-9993(93)90082-L.

    Article  CAS  PubMed  Google Scholar 

  10. Kendall KA, Leonard RJ. Bolus transit and airway protection coordination in older dysphagic patients. Laryngoscope. 2001;111:2017–21. doi:10.1097/00005537-200111000-00028.

    Article  CAS  PubMed  Google Scholar 

  11. Kahrilas PJ, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113(5):1457–64. doi:10.1053/gast.1997.v113.pm9352847.

    Article  CAS  PubMed  Google Scholar 

  12. Kim Y, McCullough GH, Asp CW. Stage transition duration in patients post-stroke. Dysphagia. 2007;22(4):299–305. doi:10.1007/s00455-007-9085-4.

    Article  PubMed  Google Scholar 

  13. Rademaker AW, Pauloski BR, Logemann JA, Shanahan TK. Oropharyngeal swallow efficiency as a representative measure of swallowing function. J Speech Hear Res. 1994;37:314–25.

    CAS  PubMed  Google Scholar 

  14. Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9:90–5. doi:10.1007/BF00714593.

    Article  CAS  PubMed  Google Scholar 

  15. Kendall KA, Leonard RJ, McKenzie S. Airway protection: evaluation with videofluoroscopy. Dysphagia. 2004;19:65–70.

    PubMed  Google Scholar 

  16. Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurosurg Psychiatry. 2007;78:141–6. doi:10.1136/jnnp.2006.101857.

    Article  CAS  Google Scholar 

  17. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Hear Speech Lang Sci. 1994;37(5):1041–59.

    CAS  Google Scholar 

  18. McCullough GH, Wertz RT, Rosenbek JC. Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke. J Commun Disord. 2001;34:55–72. doi:10.1016/S0021-9924(00)00041-1.

    Article  CAS  PubMed  Google Scholar 

  19. McCullough GH, Wertz RT, Rosenbek JC. Age, gender, size, consistency effects on swallowing function in adults between 21 and 99 years of age. Albuquerque, NM: the 10th Annual Dysphagia Research Society; 2001.

    Google Scholar 

  20. Sellars C, Campbell AM, Stott DJ, Stewart M, Wilson JA. Swallowing abnormalities after acute stroke: a case control study. Dysphagia. 1999;14(4):212–8. doi:10.1007/PL00009608.

    Article  CAS  PubMed  Google Scholar 

  21. Curtis DJ, Sepulveda GU. Epiglottic motion: video recording of muscular dysfunction. Radiology. 1983;148:473–7.

    CAS  PubMed  Google Scholar 

  22. Daniels SK, Schroeder MF, McClain M, Corey DM, Rosenbek JC, Foundas AL. Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev. 2006;43(3):347–56. doi:10.1682/JRRD.2005.01.0024.

    Article  PubMed  Google Scholar 

  23. Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–8. doi:10.1016/j.apmr.2006.11.002.

    Article  PubMed  Google Scholar 

  24. Logemann JA, Pauloski BR, Rademaker AW, Colangelo L. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40. doi:10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

This work was performed at the School of Hearing, Speech and Language Sciences, Ohio University.

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Correspondence to Youngsun Kim.

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Park, T., Kim, Y., Ko, DH. et al. Initiation and Duration of Laryngeal Closure During the Pharyngeal Swallow in Post-Stroke Patients. Dysphagia 25, 177–182 (2010). https://doi.org/10.1007/s00455-009-9237-9

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  • DOI: https://doi.org/10.1007/s00455-009-9237-9

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