Yeo Hyung Kim1, Tai Ryoon Han2, Hyung Seok Nam3, Han Gil Seo2,4, Byung-Mo Oh2,4. 1. Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 2. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 3. Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea. 4. Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. OBJECTIVES: This study aimed to investigate the temporal characteristics of PA in post-stroke patients in terms of the timing of the PA event and hyolaryngeal incoordination. METHODS: Fifty-eight swallows (38 stroke patients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters were compared between subgroups. RESULTS: Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P = 0.028), the time to maximal horizontal hyoid excursion (P = 0.010), and maximal epiglottic rotation (P = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P < 0.001). Pyriform sinus residue was observed significantly more often in the swallows with abnormal sequences (P = 0.030) than in the swallows with normal sequences. CONCLUSIONS: The timing of PA can be classified as before and during the swallow with significantly different temporal characteristics. The horizontal movement of hyoid is the most important factor associated with the pathophysiology of PA in stroke patients.
BACKGROUND: Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. OBJECTIVES: This study aimed to investigate the temporal characteristics of PA in post-strokepatients in terms of the timing of the PA event and hyolaryngeal incoordination. METHODS: Fifty-eight swallows (38 strokepatients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters were compared between subgroups. RESULTS: Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P = 0.028), the time to maximal horizontal hyoid excursion (P = 0.010), and maximal epiglottic rotation (P = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P < 0.001). Pyriform sinus residue was observed significantly more often in the swallows with abnormal sequences (P = 0.030) than in the swallows with normal sequences. CONCLUSIONS: The timing of PA can be classified as before and during the swallow with significantly different temporal characteristics. The horizontal movement of hyoid is the most important factor associated with the pathophysiology of PA in strokepatients.
Authors: Maria Regina Macedo Alves; Isabella Christina Oliveira Neto; Guilherme Maia Zica; Henrique Lederman; Maria Inês Rebelo Gonçalves Journal: Einstein (Sao Paulo) Date: 2022-03-11