Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada.
Interprofessional Practice Based Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Canada.
J Speech Lang Hear Res. 2022 Jul 18;65(7):2399-2411. doi: 10.1044/2022_JSLHR-21-00586. Epub 2022 Jun 22.
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.
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.
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.
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.
脑卒中后吞咽困难的患者可能存在食团清除效率低下或气道保护不足的情况。脑卒中后，舌压产生能力受损被认为是口咽性吞咽困难的原因之一。本研究的目的是确定在脑缺血性脑卒中后 3 个月内，是否会在一组舌力减弱的患者中观察到相似的吞咽障碍特征。
样本包括 6 名舌力减弱的成年人（即最大前向等长压力 < 40 kPa）。参与者按照标准方案进行了视频透视检查。使用吞咽生理学分析：事件、运动学和时间方法进行了事后盲法评估，并与发表的参考值进行了“典型”与“非典型”（即，在健康四分位间距内与外）的比较。
视频透视检查表明，舌力减弱并未导致常见的表现模式。在 6 名参与者中，有 2 名在稀薄液体时的渗透-误吸量表（PAS）评分≥3，伴有喉前庭闭合不全（LVC）。另外 2 名参与者的 PAS 评分为 2（短暂性渗透），但这与不完全 LVC 无关。3 名参与者的咽部残留物高于健康的第 75 百分位数。5 名参与者的舌骨 XY 峰值位置出现非典型下降。
在脑缺血性脑卒中后 3 个月内的这组成年人中，舌力减弱与吞咽生理学的多种变化同时存在。舌力减弱与透视检查中特定的损害模式之间没有直接的关系。
