Profiles of Swallowing Impairment in a Cohort of Patients With Reduced Tongue Strength Within 3 Months of Cerebral Ischemic Stroke

Abstract

Purpose: Patients with poststroke dysphagia may experience inefficient bolus clearance or inadequate airway protection. Following a stroke, impairments in lingual pressure generation capacity are thought to contribute to oropharyngeal dysphagia. The goal of our study was to determine whether similar profiles of swallowing impairment would be seen across a cohort of patients with reduced tongue strength within 3 months after cerebral ischemic stroke. Method: The sample comprised six adults with reduced tongue strength (i.e., maximum anterior isometric pressure < 40 kPa). Participants underwent a videofluoroscopy according to a standard protocol. Post hoc blinded ratings were completed using the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method and coded as “typical” versus “atypical” (i.e., within vs. outside the healthy interquartile range) in comparison to published reference values. Results: The videofluoroscopies suggested that having reduced tongue strength did not translate into a common profile. Of the six participants, two showed Penetration–Aspiration Scale (PAS) scores of ≥ 3 on thin liquids, associated with incomplete laryngeal vestibule closure (LVC). Another two participants displayed PAS scores of 2 (transient penetration), but these were not associated with incomplete LVC. Pharyngeal residue, above the healthy 75th percentile, was seen for three participants. Five participants presented with atypical reductions in hyoid XY peak position. Conclusions: In this cohort of adults within 3 months of cerebral ischemic stroke, reductions in tongue strength presented alongside a variety of changes in swallowing physiology. There was no straightforward relationship linking reduced tongue strength to particular patterns of impairment on videofluoroscopy.

Reference Values for Videofluoroscopic Measures of Swallowing: An Update

“…Clinicians might compare values in their patients to the values in the Appendix Tables, to determine whether a patient's values fall outside the range of values expected in healthy swallowing. We have recently published two articles illustrating this approach to profiling individual patients' swallowing, in case series of patients with dysphagia following traumatic spinal cord injury ( Valenzano et al, 2023 ) and supratentorial ischemic stroke ( Smaoui, Peladeau-Pigeon, Mancopes, et al, 2022 ). When using the reference tables to guide the interpretation of individual patient-level VFSS findings, it is important to bear in mind the previously stated cautions regarding generalizability of these reference values to data collected using different methods (e.g., bolus volumes, cued swallows, brands, and concentrations of contrast media).…”

“…Examples of this use scenario can be found in several recent publications from our lab, including analyses in preliminary samples of adults with amyotrophic lateral sclerosis (ALS; Waito et al, 2020 ), Parkinson's disease (PD; Gandhi et al, 2021 ), oropharyngeal cancer treated with radiation ( Barbon et al, 2020 ), and chronic obstructive pulmonary disease ( Mancopes et al, 2020 ). We have also used the frequency of atypical values in odds ratio analyses and logistic regression models to explore mechanisms of impairment leading to penetration and aspiration ( Smaoui et al, 2022 ; Steele, Peladeau-Pigeon, Barrett, et al, 2020 ). One limitation of this work to date has been the challenge of recruiting large samples of patients at similar stages of disease progression or severity.…”