Top

Published in:

Open Access 18-04-2023 | Stroke | Original Article

Quantitative Analysis of Temporal Parameters Correlated with Aspiration and Lesion Location in Stroke Patients

Authors: Jeong Min Kim, Ji Eun Park, Seung Jun Baek, Seung Nam Yang

Published in: Dysphagia | Issue 6/2023

Abstract

The purpose of this study was to identify differences in temporal parameters correlating to the presence of aspiration and the severity of penetration-aspiration scale (PAS) in patients with dysphagia after stroke. We also investigated whether there was a significant difference in temporal parameters based on the location of the stroke lesion. A total of 91 patient videofluoroscopic swallowing study (VFSS) videos of stroke patients with dysphagia were retrospectively analyzed. Various temporal parameters including oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, upper esophageal sphincter opening duration and upper esophageal sphincter reaction time were measured. Subjects were grouped by the presence of aspiration, PAS score, and location of the stroke lesion. Pharyngeal response time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration were significantly prolonged in the aspiration group. These three factors showed positive correlation with PAS. In terms of stroke lesion, oral phase duration was significantly prolonged in the supratentorial lesion group, while upper esophageal sphincter opening duration was significantly prolonged in the infratentorial lesion group. We have demonstrated that quantitative temporal analysis of VFSS can be a clinically valuable tool identifying dysphagia pattern associated with stroke lesion or aspiration risk.

Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia. 2016;31(3):434–41. https://doi.org/10.1007/s00455-016-9695-9.CrossRefPubMed

Jones CA, Colletti CM, Ding MC. Post-stroke dysphagia: recent insights and unanswered questions. Curr Neurol Neurosci Rep. 2020;20(12):61. https://doi.org/10.1007/s11910-020-01081-z.CrossRefPubMedPubMedCentral

Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81. https://doi.org/10.1007/pl00009559.CrossRefPubMed

Martin BJ, Corlew MM, Wood H, Olson D, Golopol LA, Wingo M, Kirmani N. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia. 1994;9(1):1–6. https://doi.org/10.1007/bf00262751.CrossRefPubMed

Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49–59. https://doi.org/10.1038/nrgastro.2015.199.CrossRefPubMed

Clavé P, Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig. 2004;96(2):119–31. https://doi.org/10.4321/s1130-01082004000200005.CrossRefPubMed

Logemann JA. Evaluation and treatment of swallowing disorders. Curr Opin Otolaryngol Head Neck Surg. 1998;6(6):395–400.CrossRef

Scott A, Perry A, Bench J. A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia. 1998;13(4):223–7. https://doi.org/10.1007/pl00009576.CrossRefPubMed

Baijens L, Barikroo A, Pilz W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur J Radiol. 2013;82(10):1683–95. https://doi.org/10.1016/j.ejrad.2013.05.009.CrossRefPubMed

10.

Steele CM, Peladeau-Pigeon M, Barbon CAE, et al. Reference values for healthy swallowing across the range from thin to extremely thick liquids. J Speech Lang Hear Res. 2019;62(5):1338–63. https://doi.org/10.1044/2019_jslhr-s-18-0448.CrossRefPubMedPubMedCentral

11.

Waito AA, Steele CM, Peladeau-Pigeon M, Genge A, Argov Z. A preliminary videofluoroscopic investigation of swallowing physiology and function in individuals with Oculopharyngeal Muscular Dystrophy (OPMD). Dysphagia. 2018;33(6):789–802. https://doi.org/10.1007/s00455-018-9904-9.CrossRefPubMed

12.

Kang BS, Oh BM, Kim IS, Chung SG, Kim SJ, Han TR. Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis. Gerontology. 2010;56(5):474–82. https://doi.org/10.1159/000274517.CrossRefPubMed

13.

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(6):523–9. https://doi.org/10.1097/00004424-198411000-00009.CrossRefPubMed

14.

Kendall KA, Leonard RJ. Hyoid movement during swallowing in older patients with dysphagia. Arch Otolaryngol Head Neck Surg. 2001;127(10):1224–9. https://doi.org/10.1001/archotol.127.10.1224.CrossRefPubMed

15.

Hamlet SL, Muz J, Patterson R, Jones L. Pharyngeal transit time: assessment with videofluoroscopic and scintigraphic techniques. Dysphagia. 1989;4(1):4–7. https://doi.org/10.1007/bf02407396.CrossRefPubMed

16.

Guedes R, Azola A, Macrae P, Sunday K, Mejia V, Vose A, Humbert IA. Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults. Physiol Behav. 2017;174:155–61. https://doi.org/10.1016/j.physbeh.2017.03.018.CrossRefPubMedPubMedCentral

17.

Park YH, Jun BC, Song CE, Park CS, Kim MS, Cho SH, Logemann JA. Temporal analysis of oropharyngeal swallow in children. Korean J Otolaryngol-Head Neck Surg. 2004;47(7):661–4.

18.

Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20(4):290–6. https://doi.org/10.1007/s00455-005-0029-6.CrossRefPubMed

19.

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. https://doi.org/10.1044/1092-4388(2002/034).CrossRefPubMed

20.

Kendall KA, McKenzie S, Leonard RJ, Gonçalves MI, Walker A. Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15(2):74–83. https://doi.org/10.1007/s004550010004.CrossRefPubMed

21.

Kendall KA, Leonard RJ. Pharyngeal constriction in elderly dysphagic patients compared with young and elderly nondysphagic controls. Dysphagia. 2001;16(4):272–8. https://doi.org/10.1007/s00455-001-0086-4.CrossRefPubMed

22.

Saconato M, Leite FC, Lederman HM, Chiari BM, Gonçalves MIR. Temporal and sequential analysis of the pharyngeal phase of swallowing in poststroke patients. Dysphagia. 2020;35(4):598–615. https://doi.org/10.1007/s00455-019-10069-y.CrossRefPubMed

23.

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(3):177–82. https://doi.org/10.1007/s00455-009-9237-9.CrossRefPubMed

24.

Molfenter SM, Steele CM. Kinematic and temporal factors associated with penetration-aspiration in swallowing liquids. Dysphagia. 2014;29(2):269–76. https://doi.org/10.1007/s00455-013-9506-5.CrossRefPubMedPubMedCentral

25.

Park T, Kim Y, McCullough G. Oropharyngeal transition of the bolus in post-stroke patients. Am J Phys Med Rehabil. 2013;92(4):320–6. https://doi.org/10.1097/phm.0b013e318269d935.CrossRefPubMed

26.

Miyaji H, Umezaki T, Adachi K, Sawatsubashi M, Kiyohara H, Inoguchi T, To S, Komune S. Videofluoroscopic assessment of pharyngeal stage delay reflects pathophysiology after brain infarction. Laryngoscope. 2012;122(12):2793–9. https://doi.org/10.1002/lary.23588.CrossRefPubMed

27.

Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78(2):141–6. https://doi.org/10.1136/jnnp.2006.101857.CrossRefPubMed

28.

Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil. 1985;66(6):372–5.PubMed

29.

Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82(5):677–82. https://doi.org/10.1053/apmr.2001.21939.CrossRefPubMed

30.

Johnson ER, McKenzie SW, Rosenquist CJ, Lieberman JS, Sievers AE. Dysphagia following stroke: quantitative evaluation of pharyngeal transit times. Arch Phys Med Rehabil. 1992;73(5):419–23.PubMed

31.

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(3):257–64. https://doi.org/10.1007/s00455-008-9198-4.CrossRefPubMed

32.

Cabib C, Ortega O, Kumru H, et al. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann N Y Acad Sci. 2016;1380(1):121–38. https://doi.org/10.1111/nyas.13135.CrossRefPubMed

33.

Kim Y, Park T, Oommen E, McCullough G. Upper esophageal sphincter opening during swallow in stroke survivors. Am J Phys Med Rehabil. 2015;94(9):734–9. https://doi.org/10.1097/phm.0000000000000258.CrossRefPubMed

34.

Kim YK, Cha JH, Lee KY. Comparison of dysphagia between infratentorial and supratentorial stroke patients. Ann Rehabil Med. 2019;43(2):149–55. https://doi.org/10.5535/arm.2019.43.2.149.CrossRefPubMedPubMedCentral

35.

Lim SH, Lieu PK, Phua SY, Seshadri R, Venketasubramanian N, Lee SH, Choo PW. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia. 2001;16(1):1–6. https://doi.org/10.1007/s004550000038.CrossRefPubMed

36.

Chong MS, Lieu PK, Sitoh YY, Meng YY, Leow LP. Bedside clinical methods useful as screening test for aspiration in elderly patients with recent and previous strokes. Ann Acad Med Singap. 2003;32(6):790–4.PubMed

37.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. https://doi.org/10.1007/bf00417897.CrossRefPubMed

38.

Robbins J, Levine RL, Maser A, Rosenbek JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993;74(12):1295–300. https://doi.org/10.1016/0003-9993(93)90082-l.CrossRefPubMed

39.

Logemann JA, Shanahan T, Rademaker AW, Kahrilas PJ, Lazar R, Halper A. Oropharyngeal swallowing after stroke in the left basal ganglion/internal capsule. Dysphagia. 1993;8(3):230–4. https://doi.org/10.1007/bf01354543.CrossRefPubMed

40.

Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38(3):556–63. https://doi.org/10.1044/jshr.3803.556.CrossRefPubMed

41.

Alves TC, Cola PC, Jorge AG, Gatto AR, Da Silva RG. Relationship between pharyngeal response time and lateralized brain lesion in stroke. Top Stroke Rehabil. 2019;26(6):435–9.CrossRefPubMed

42.

Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9(2):90–5. https://doi.org/10.1007/bf00714593.CrossRefPubMed

43.

Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, Lin S. Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol. 1992;262(2 Pt 1):G338–44. https://doi.org/10.1152/ajpgi.1992.262.2.G338.CrossRefPubMed

44.

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. https://doi.org/10.1053/gast.1997.v113.pm9352847.CrossRefPubMed

45.

Clavé P, de Kraa M, Arreola V, Girvent M, Farré R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–94. https://doi.org/10.1111/j.1365-2036.2006.03118.x.CrossRefPubMed

46.

Daniels SK, Pathak S, Mukhi SV, Stach CB, Morgan RO, Anderson JA. The relationship between lesion localization and dysphagia in acute stroke. Dysphagia. 2017;32(6):777–84. https://doi.org/10.1007/s00455-017-9824-0.CrossRefPubMed

47.

Moon HI, Pyun SB, Kwon HK. Correlation between location of brain lesion and cognitive function and findings of videofluoroscopic swallowing study. Ann Rehabil Med. 2012;36(3):347–55. https://doi.org/10.5535/arm.2012.36.3.347.CrossRefPubMedPubMedCentral

48.

Jo SY, Hwang JW, Pyun SB. Relationship between cognitive function and dysphagia after stroke. Ann Rehabil Med. 2017;41(4):564–72. https://doi.org/10.5535/arm.2017.41.4.564.CrossRefPubMedPubMedCentral

49.

Seçil Y, Arıcı Ş, İncesu TK, Gürgör N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer’s disease. Neurophysiol Clin. 2016;46(3):171–8. https://doi.org/10.1016/j.neucli.2015.12.007.CrossRefPubMed

50.

Steinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40(5):1903–6. https://doi.org/10.1161/strokeaha.108.535468.CrossRefPubMed

51.

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63. https://doi.org/10.1161/01.STR.0000190056.76543.eb.CrossRefPubMed

52.

Martino R, Terrault N, Ezerzer F, Mikulis D, Diamant NE. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Gastroenterology. 2001;121(2):420–6. https://doi.org/10.1053/gast.2001.26291.CrossRefPubMed

Title: Quantitative Analysis of Temporal Parameters Correlated with Aspiration and Lesion Location in Stroke Patients
Authors: Jeong Min Kim
Ji Eun Park
Seung Jun Baek
Seung Nam Yang
Publication date: 18-04-2023
Publisher: Springer US
Keywords: Stroke
Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Dysphagia
Dysphagia
Dysphagia
Published in: Dysphagia / Issue 6/2023
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-023-10575-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quantitative Analysis of Temporal Parameters Correlated with Aspiration and Lesion Location in Stroke Patients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2023

Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial

Comprehensive Manometric Evaluation of Dysphagia in Patients with Down Syndrome

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

The Role of Bolus Residue and Its Relation with Respiratory Problems in Children with Esophageal Atresia

Single-Versus Multiple-Dose Antimicrobial Prophylaxis in Peroral Endoscopic Myotomy: A Randomized Controlled Study (SMAPP Trial)

Brain and Pharyngeal Responses Associated with Pharmacological Treatments for Oropharyngeal Dysphagia in Older Patients