Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
Dysphagia. 2023 Feb;38(1):227-235. doi: 10.1007/s00455-022-10458-w. Epub 2022 May 4.
Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.
本研究旨在探讨脑卒中后口腔失用症对亚急性脑卒中患者吞咽困难的影响。我们回顾性分析了 2015 年 1 月至 2021 年 2 月期间 130 例幕上脑卒中患者的临床资料，这些患者均接受了正规的肢体和口腔失用症测试以及视频透视吞咽研究（VFSS），并将这些患者分为两组：失用症组和非失用症组（口腔失用症评分分别>45 分和≤45 分）。所有患者均参与了标准化测试。测试变量包括视频透视吞咽困难量表（VDS）、口腔通过时间（OTT）、咽部延迟时间（PDT）、咽部通过时间和渗透-吸入量表（PAS）；我们使用这些参数进行多变量回归分析，以确认口腔失用症作为脑卒中后吞咽困难的临床决定因素的意义。在失用症组和非失用症组中，口腔失用症评分的平均值分别为 38.4 分和 47.6 分（p<0.001）。与非失用症组相比，失用症组的 2 毫升厚液 OTT 延迟的比例更高（17.6%和 4.2%；p=0.011）。口腔失用症是 VDS 的显著决定因素（p<0.001），2 毫升厚液的 OTT 延迟（p=0.028）、薄液杯饮的 PDT 延迟（p=0.044）和 PAS 评分（p=0.003）。口腔失用症的存在与吞咽困难显著相关，特别是与吞咽的口腔相（厚液）、咽相（薄液杯饮）的 VFSS 参数以及亚急性脑卒中患者的误吸风险增加相关。因此，对于有吞咽困难的脑卒中患者，需要进行正规的口腔失用症评估。
