Predicting Aspiration After Hemispheric Stroke from Timing Measures of Oropharyngeal Bolus Flow and Laryngeal Closure

Abstract

Deglutitive aspiration is common after stroke, affecting up to 50% of patients and predisposing them to pneumonia, yet it is virtually impossible to predict those patients at greatest risk. The aim of this study was to develop a robust predictive model for aspiration after stroke. Swallowing was assessed by digital videofluoroscopy (VF) in 90 patients following hemispheric stroke. Lesion characteristics were determined by computerized tomography (CT) brain scan using the Alberta Stroke Programme Early CT Score (ASPECTS). Aspiration severity was measured using a validated penetration-aspiration scale. The probability of aspiration was then determined from measures of swallowing pathophysiology and lesion location by discriminant analysis. Aspiration was observed in 47 (52%) patients, yet despite disrupted swallowing physiology, intrasubject aspiration scores were variable. The best discriminant model combined pharyngeal transit time, swallow response time, and laryngeal closure duration to predict 73.11% of those aspirating (sensitivity = 66.54, specificity = 80.22, p > 0.001). The addition of lesion location did not add anything further to the predictive model. We conclude that the pathophysiology of poststroke aspiration is multifactorial but in most cases can be predicted by three key swallowing measurements. These measurements, if translatable into clinical bedside evaluation, may assist with the development of novel measurement and intervention techniques to detect and treat poststroke aspiration.

Instrumento de rastreio para disfagia orofaríngea no Acidente Vascular Encefálico - Parte I: evidências de validade baseadas no conteúdo e nos processos de resposta

“…Others were excluded because of the lack of scientific proof of the relation of dysphagia with voluntary cough, nausea reflex (19,20) and laterality of the injury (21,22) .…”

Efeito do sabor azedo e da temperatura fria na fase oral da deglutição no acidente vascular encefálico

“…milissegundos entre o frame mostrando a parte proximal do bolo alimentar no ângulo da borda inferior da mandíbula com a base da língua até o primeiro frame mostrando o movimento de elevação de laringe (Power et al, 2009;Logemann et al, 1995). Figura 6.…”

“…Não foi constatada diferença estatística entre os grupos 1 e 2. Lazara et al, 1986;Shaker et al,1988;Ali et al, 1996;Kendal et al, 2000;Martin-Harris et al, 2005;Stephen et al, 2005, Power et al, 2009). …”

“…As mudanças favoráveis nestes tempos, tais como sua redução, poderiam minimizar os riscos de aspiração laringotraqueal e consequentemente de complicações broncopulmonares (Power et al, 2009). …”

“…Em seu recente estudo com pacientes pós -AVE, Power et al (2009) Assim, da mesma forma que a temperatura, o volume e a textura são conhecidos por modular o comportamento da deglutição (Cook et al, 1989;Dantas et al, 1990;Robbins et al, 1992;Bish et al, 1994;Power et al, 2007), outros estudos vêm tentando ampliar e aprofundar as investigações neste campo e entender o real papel do sabor e suas diferentes intensidades na função de deglutição (Logemann et al, 1995;Hamdy et al, 2003;Pelletier et al, 2003).…”