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Published in: Dysphagia 3/2017

01-06-2017 | Original Article

Swallowing Function and Kinematics in Stroke Patients with Tracheostomies

Authors: Han Gil Seo, Jeong-Gil Kim, Hyung Seok Nam, Woo Hyung Lee, Tai Ryoon Han, Byung-Mo Oh

Published in: Dysphagia | Issue 3/2017

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Abstract

The purpose of this study was to compare the swallowing function and kinematics in stroke patients with and without tracheostomies. In this retrospective matched case–control study, we compared stroke patients with (TRACH group, n = 24) and without (NO-TRACH group, n = 24) tracheostomies. Patients were matched for age, sex, and stroke-type. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) and functional oral intake scale (FOIS) obtained from videofluoroscopic swallow study (VFSS) images. Swallowing kinematics were evaluated using a two-dimensional kinematic analysis of the VFSS images. Mean duration of tracheostomy was 132.38 ± 150.46 days in the TRACH group. There was no significant difference in the total VDS score between the TRACH (35.17 ± 15.30) and NO-TRACH groups (29.25 ± 16.66, p = 0.247). FOIS was significantly lower in the TRACH group (2.33 ± 1.40) than in the NO-TRACH group (4.33 ± 1.79, p = 0.001). The TRACH group had a significantly lower maximum vertical displacement (15.23 ± 7.39 mm, p = 0.011) and velocity (54.99 ± 29.59 mm/s, p = 0.011), and two-dimensional velocity (61.07 ± 24.89 mm/s, p = 0.013) of the larynx than the NO-TRACH group (20.18 ± 5.70 mm, 82.23 ± 37.30 mm/s, and 84.40 ± 36.05 mm/s, respectively). Maximum horizontal velocity of the hyoid bone in the TRACH group (36.77 ± 16.97 mm/s) was also significantly lower than that in the NO-TRACH group (47.49 ± 15.73 mm/s, p = 0.032). This study demonstrated that stroke patients with tracheostomies had inferior swallowing function and kinematics than those without tracheostomies. A prospective longitudinal study is needed to elucidate the effect of a tracheostomy on swallowing recovery in stroke patients.
Literature
1.
go back to reference Roth EJ, Lovell L, Harvey RL, Bode RK, Heinemann AW. Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke. 2002;33:1845–50.CrossRefPubMed Roth EJ, Lovell L, Harvey RL, Bode RK, Heinemann AW. Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke. 2002;33:1845–50.CrossRefPubMed
2.
go back to reference Walcott BP, Kamel H, Castro B, Kimberly WT, Sheth KN. Tracheostomy after severe ischemic stroke: a population-based study. J Stroke Cerebrovasc Dis. 2014;23:1024–9.CrossRefPubMed Walcott BP, Kamel H, Castro B, Kimberly WT, Sheth KN. Tracheostomy after severe ischemic stroke: a population-based study. J Stroke Cerebrovasc Dis. 2014;23:1024–9.CrossRefPubMed
3.
5.
go back to reference DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med. 1990;18:1328–30.CrossRefPubMed DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med. 1990;18:1328–30.CrossRefPubMed
6.
go back to reference Nash M. Swallowing problems in the tracheotomized patient. Otolaryngol Clin N Am. 1988;21:701–9. Nash M. Swallowing problems in the tracheotomized patient. Otolaryngol Clin N Am. 1988;21:701–9.
7.
go back to reference Cameron JL, Reynolds J, Zuidema GD. Aspiration in patients with tracheostomies. Surg Gynecol Obstet. 1973;136:68–70.PubMed Cameron JL, Reynolds J, Zuidema GD. Aspiration in patients with tracheostomies. Surg Gynecol Obstet. 1973;136:68–70.PubMed
8.
go back to reference Muz J, Mathog RH, Nelson R, Jones LA Jr. Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol. 1989;10:282–6.CrossRefPubMed Muz J, Mathog RH, Nelson R, Jones LA Jr. Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol. 1989;10:282–6.CrossRefPubMed
9.
go back to reference Elpern EH, Scott MG, Petro L, Ries MH. Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest. 1994;105:563–6.CrossRefPubMed Elpern EH, Scott MG, Petro L, Ries MH. Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest. 1994;105:563–6.CrossRefPubMed
10.
go back to reference Feldman SA, Deal CW, Urquhart W. Disturbance of swallowing after tracheostomy. Lancet. 1966;1:954–5.CrossRefPubMed Feldman SA, Deal CW, Urquhart W. Disturbance of swallowing after tracheostomy. Lancet. 1966;1:954–5.CrossRefPubMed
12.
go back to reference Eibling DE, Gross RD. Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol. 1996;105:253–8.CrossRefPubMed Eibling DE, Gross RD. Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol. 1996;105:253–8.CrossRefPubMed
13.
go back to reference Clarett M, Andreu MF, Salvati IG, Donnianni MC, Montes GS, Rodriguez MG. Effect of subglottic air insufflation on subglottic pressure during swallowing. Med Intensiva. 2014;38:133–9.CrossRefPubMed Clarett M, Andreu MF, Salvati IG, Donnianni MC, Montes GS, Rodriguez MG. Effect of subglottic air insufflation on subglottic pressure during swallowing. Med Intensiva. 2014;38:133–9.CrossRefPubMed
14.
go back to reference Donzelli J, Brady S, Wesling M, Theisen M. Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia. 2005;20:283–9.CrossRefPubMed Donzelli J, Brady S, Wesling M, Theisen M. Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia. 2005;20:283–9.CrossRefPubMed
15.
go back to reference Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia. 2010;25:35–9.CrossRefPubMed Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia. 2010;25:35–9.CrossRefPubMed
16.
go back to reference Terk AR, Leder SB, Burrell MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia. 2007;22:89–93.CrossRefPubMed Terk AR, Leder SB, Burrell MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia. 2007;22:89–93.CrossRefPubMed
17.
go back to reference Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia. 2012;27:498–503.CrossRefPubMed Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia. 2012;27:498–503.CrossRefPubMed
18.
go back to reference Prigent H, Lejaille M, Terzi N, Annane D, Figere M, Orlikowski D, Lofaso F. Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Med. 2012;38:85–90.CrossRefPubMed Prigent H, Lejaille M, Terzi N, Annane D, Figere M, Orlikowski D, Lofaso F. Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Med. 2012;38:85–90.CrossRefPubMed
19.
go back to reference Amathieu R, Sauvat S, Reynaud P, Slavov V, Luis D, Dinca A, Tual L, Bloc S, Dhonneur G. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Br J Anaesth. 2012;109:578–83.CrossRefPubMed Amathieu R, Sauvat S, Reynaud P, Slavov V, Luis D, Dinca A, Tual L, Bloc S, Dhonneur G. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Br J Anaesth. 2012;109:578–83.CrossRefPubMed
20.
go back to reference Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.CrossRefPubMed Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.CrossRefPubMed
21.
go back to reference Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The natural history of dysphagia following a stroke. Dysphagia. 1997;12:188–93.CrossRefPubMed Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The natural history of dysphagia following a stroke. Dysphagia. 1997;12:188–93.CrossRefPubMed
22.
go back to reference Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.CrossRefPubMed Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.CrossRefPubMed
23.
go back to reference Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23:59–64.CrossRefPubMed Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23:59–64.CrossRefPubMed
24.
go back to reference Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–20.CrossRefPubMed Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–20.CrossRefPubMed
25.
go back to reference Seo HG, Oh BM, Han TR. Longitudinal changes of the swallowing process in subacute stroke patients with aspiration. Dysphagia. 2011;26:41–8.CrossRefPubMed Seo HG, Oh BM, Han TR. Longitudinal changes of the swallowing process in subacute stroke patients with aspiration. Dysphagia. 2011;26:41–8.CrossRefPubMed
26.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
27.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
29.
go back to reference Conway A, Rolley JX, Fulbrook P, Page K, Thompson DR. Improving statistical analysis of matched case–control studies. Res Nurs Health. 2013;36:320–4.CrossRefPubMed Conway A, Rolley JX, Fulbrook P, Page K, Thompson DR. Improving statistical analysis of matched case–control studies. Res Nurs Health. 2013;36:320–4.CrossRefPubMed
30.
go back to reference Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000;38:219–42.CrossRefPubMed Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000;38:219–42.CrossRefPubMed
31.
go back to reference Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W. Deglutitive aspiration in patients with tracheostomy: effect of tracheostomy on the duration of vocal cord closure. Gastroenterology. 1995;108:1357–60.CrossRefPubMed Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W. Deglutitive aspiration in patients with tracheostomy: effect of tracheostomy on the duration of vocal cord closure. Gastroenterology. 1995;108:1357–60.CrossRefPubMed
32.
go back to reference Ding R, Logemann JA. Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study. Head Neck. 2005;27:809–13.CrossRefPubMed Ding R, Logemann JA. Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study. Head Neck. 2005;27:809–13.CrossRefPubMed
34.
go back to reference Seo HG, Oh BM, Han TR. Swallowing kinematics and factors associated with laryngeal penetration and aspiration in stroke survivors with dysphagia. Dysphagia. 2016;31:160–8.CrossRefPubMed Seo HG, Oh BM, Han TR. Swallowing kinematics and factors associated with laryngeal penetration and aspiration in stroke survivors with dysphagia. Dysphagia. 2016;31:160–8.CrossRefPubMed
35.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
Metadata
Title
Swallowing Function and Kinematics in Stroke Patients with Tracheostomies
Authors
Han Gil Seo
Jeong-Gil Kim
Hyung Seok Nam
Woo Hyung Lee
Tai Ryoon Han
Byung-Mo Oh
Publication date
01-06-2017
Publisher
Springer US
Published in
Dysphagia / Issue 3/2017
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-016-9767-x

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