University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.
University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand; Department of Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand.
Arch Phys Med Rehabil. 2021 May;102(5):895-904. doi: 10.1016/j.apmr.2020.11.014. Epub 2020 Dec 22.
To identify and characterize subgroups of stroke patients with clinical signs of dysphagia, based on swallowing-related strength and skill impairments of the submental muscle group.
Prospective observational study.
Inpatient rehabilitation centers and community dwellings.
Individuals (N=114), including stroke patients with dysphagia (n=55) and 2 control groups including myopathic patients with dysphagia (n=19) and healthy volunteers (n=40) were included in this study.
Not applicable.
Novel clinical assessment of strength (force generation) and skill (spatial and temporal precision of muscle activation) of the submental muscle group during swallowing and nonswallowing behaviors, using surface electromyography and dynamometry.
Hierarchical cluster analysis revealed 4 clusters, which could be broadly characterized as cluster 1: intact strength and skill, cluster 2: poor strength and poor nonswallowing skill, cluster 3: poor strength, and cluster 4: poor strength and poor swallowing skill. Membership in cluster was significantly associated with medical diagnosis (P<.001). The majority of healthy and myopathic participants were assigned to clusters 1 and 3, respectively, whereas stroke patients were found in all 4 clusters. Skill outcome measures were more predictive of cluster assignment than strength measures.
Although healthy and myopathic participants demonstrated predominantly homogeneous swallowing patterns of submental muscle function within their etiology, several subgroups were identified within stroke, possibly reflecting different subtypes of swallowing function. Future research should focus on the nature and rehabilitation needs of these subtypes. Assessment of skill in swallowing may be an important but overlooked aspect of rehabilitation.
根据颏下肌群与吞咽相关的力量和技能损伤，识别和描述具有吞咽困难临床症状的脑卒中患者亚组，并对其进行特征描述。
前瞻性观察性研究。
住院康复中心和社区住所。
共纳入 114 名个体，包括吞咽困难的脑卒中患者（n=55）和 2 个对照组，包括吞咽困难的肌病患者（n=19）和健康志愿者（n=40）。
无。
采用表面肌电图和测力法对颏下肌群在吞咽和非吞咽行为时的力量（肌力产生）和技能（肌肉激活的时空精度）进行新型临床评估。
层次聚类分析显示，可将患者分为 4 组，大致可分为：第 1 组：肌力和技能完整；第 2 组：肌力差且非吞咽技能差；第 3 组：肌力差；第 4 组：肌力差且吞咽技能差。聚类成员身份与医学诊断显著相关（P<.001）。大多数健康和肌病患者分别归入第 1 组和第 3 组，而脑卒中患者则存在于 4 个组中。技能评估结果比力量评估结果更能预测聚类分配。
尽管健康和肌病参与者的颏下肌群吞咽功能表现出与其病因基本一致的均匀模式，但在脑卒中患者中发现了几个亚组，可能反映了不同类型的吞咽功能。未来的研究应侧重于这些亚型的性质和康复需求。评估吞咽能力可能是康复中一个重要但被忽视的方面。
