Park Taeok, Kim Youngsun, Oh Byung-Mo
Communication Sciences and Disorders, College of Art and Science, Illinois State University, Normal, Illinois.
Communication Sciences and Disorders, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio.
J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1766-1772. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.003. Epub 2017 Apr 26.
One of the major, and most harmful, symptoms of dysphagia in stroke survivors is aspiration. Survivors of unilateral cortical strokes with dysphagia and resulting aspiration have been reported to have greater initiation delays in laryngeal closure than those who did not aspirate. Few studies have reported such data in survivors of subcortical stroke.
This study measured initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in 2 groups of subjects: 15 stroke survivors with cortical lesions and 15 stroke survivors with subcortical lesions. Means and standard deviations of ILC and LCD were analyzed on 5-mL thin liquid and 5-mL puree boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations. Statistical comparisons were used by repeated measures analysis of variance. Significance level was set at P < .05.
ILC was significantly longer in stroke survivors with a subcortical lesion than in those with a cortical lesion for both bolus consistencies. However, there were no significant differences between the 2 groups in LCD. Stroke survivors with a subcortical lesion had a greater incidence of penetration or aspiration and silent aspiration than those with a cortical lesion and a longer delay in the ILC.
Subcortical lesions may put these survivors at greater risk of aspiration due to delayed initial laryngeal closure and reduced oral and laryngeal sensation. The subcortical damage, which occurs at the basal ganglia, may interrupt the ILC.
吞咽困难在中风幸存者中最主要且危害最大的症状之一是误吸。据报道，单侧皮质中风且伴有吞咽困难及由此导致误吸的幸存者，其喉关闭起始延迟比未发生误吸的幸存者更大。很少有研究报道皮质下中风幸存者的此类数据。
本研究测量了两组受试者的喉关闭起始（ILC）和喉关闭持续时间（LCD）：15例有皮质病变的中风幸存者和15例有皮质下病变的中风幸存者。在随后的视频荧光吞咽检查分析过程中，使用100毫秒定时器对5毫升稀液体和5毫升泥状食团的ILC和LCD的均值及标准差进行分析。采用重复测量方差分析进行统计学比较。显著性水平设定为P < 0.05。
对于两种食团质地，有皮质下病变的中风幸存者的ILC明显长于有皮质病变的幸存者。然而，两组之间的LCD没有显著差异。有皮质下病变的中风幸存者比有皮质病变的幸存者发生渗透或误吸以及隐匿性误吸的发生率更高，且ILC延迟更长。
皮质下病变可能使这些幸存者因喉关闭起始延迟以及口腔和喉部感觉减退而面临更高的误吸风险。发生在基底神经节的皮质下损伤可能会中断ILC。
