Paitoon Benjapornlert1,2, Hitoshi Kagaya1, Yoko Inamoto3, Eriko Mizokoshi1, Seiko Shibata1, Eiichi Saitoh1. 1. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. 2. Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI, Ratchathewi, Bangkok, 10400, Thailand. 3. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Abstract
BACKGROUND: Dysphagia is a common problem in patients with a history of stroke. In Japan, a reclined position is commonly used as a compensatory technique to address this problem. OBJECTIVE: To evaluate the effect of reclined position on swallowing function in patients with stroke who had dysphagia METHODS: A retrospective analysis was carried out on the videofluoroscopic examination of swallowing (VF) of 4ml honey-thick liquid swallows collected over nine years. Penetration-aspiration scale (PAS) and residue scores were compared for the following: a body position at 90° upright (90°U) and 60° reclining (60°R) groups, as well as 60°R and 45° reclining (45°R) groups. RESULTS: Two hundred and five records from 98 subjects were reviewed. These included patients with ischemic stroke (62%), hemorrhagic stroke (32%), and subarachnoid hemorrhage (6%). PAS scores were lower when the body was in a more reclined position (P < 0.001). The amount of residue in the valleculae and pyriform sinus also reduced in the more reclined position (P < 0.001). The deeper bolus head at swallowing onset was positively correlated with severe PAS (P < 0.001). CONCLUSIONS: These findings suggest that in patients with stroke who had dysphagia, a reclined position may be useful in reducing the risk of penetration and aspiration, and in decreasing the amount of residue in the pharyngeal area. The depth of the bolus head at the onset of swallowing increases the severity of penetration and aspiration. This article is protected by copyright. All rights reserved.
BACKGROUND:Dysphagia is a common problem in patients with a history of stroke. In Japan, a reclined position is commonly used as a compensatory technique to address this problem. OBJECTIVE: To evaluate the effect of reclined position on swallowing function in patients with stroke who had dysphagia METHODS: A retrospective analysis was carried out on the videofluoroscopic examination of swallowing (VF) of 4ml honey-thick liquid swallows collected over nine years. Penetration-aspiration scale (PAS) and residue scores were compared for the following: a body position at 90° upright (90°U) and 60° reclining (60°R) groups, as well as 60°R and 45° reclining (45°R) groups. RESULTS: Two hundred and five records from 98 subjects were reviewed. These included patients with ischemic stroke (62%), hemorrhagic stroke (32%), and subarachnoid hemorrhage (6%). PAS scores were lower when the body was in a more reclined position (P < 0.001). The amount of residue in the valleculae and pyriform sinus also reduced in the more reclined position (P < 0.001). The deeper bolus head at swallowing onset was positively correlated with severe PAS (P < 0.001). CONCLUSIONS: These findings suggest that in patients with stroke who had dysphagia, a reclined position may be useful in reducing the risk of penetration and aspiration, and in decreasing the amount of residue in the pharyngeal area. The depth of the bolus head at the onset of swallowing increases the severity of penetration and aspiration. This article is protected by copyright. All rights reserved.