Girod-Roux Marion, Guiu Hernandez Esther, Ng Karen B, Macrae Phoebe R, Huckabee Maggie-Lee
Grenoble Alpes University Hospital, BP 217, Cedex 09, Grenoble, 38043, France.
University of Canterbury Rose Centre for Stroke Recovery and Research, St George's Medical Centre, Level One, Leinster Chambers, 249 Papanui Road, Merivale, Christchurch, 8014, New Zealand.
Dysphagia. 2024 Dec 21. doi: 10.1007/s00455-024-10796-x.
The role of pathophysiological deficits in the evolution of dysphagia post-stroke is unclear. This observational, longitudinal study aimed to document the evolution and relationship between strength and precision of submental contraction, and swallowing outcomes at six months. Participants were recruited from a tertiary acute hospital after a first acute stroke. Sociodemographic data and stroke typology were documented. Outcome measures were collected five times across six months. These included: oral diet (FOIS, IDDSI), functional ingestion (TOMASS, TWST), self-reported swallowing-related quality of life (SWAL-QOL), and submental muscle strength and precision contraction as assessed using surface electromyography coupled with biofeedback during saliva swallowing and jaw-opening tasks. Mixed effects models and multiple regressions analyses were conducted. Participants (N = 22, mean age 73.9 ± 14.4 years, 9 males) were recruited at a mean time of 2.8 ± 1.5 days after stroke. Strength parameters (effortful swallow hit rate) improved between ten days and one month post-stroke (p = 0.04). Swallowing temporal precision improved significantly between one and six months (p < 0.01). At six months, participants with decreased swallowing precision also had decreased quality of life (p = 0.04) and increased ingestion time of fluids (p = 0.002). This study is a novel step in exploring the nature and evolution of strength and precision parameters of swallowing muscle activation, and their impact on dysphagia recovery. As swallowing precision was associated with poorer functional outcomes, further studies are warranted to improve early differential diagnosis of patients at risk of chronic dysphagia.
病理生理缺陷在中风后吞咽困难演变过程中的作用尚不清楚。这项观察性纵向研究旨在记录颏下收缩的力量和精确度在六个月内的演变及其与吞咽结果之间的关系。参与者来自一家三级急性医院，均为首次发生急性中风。记录了社会人口统计学数据和中风类型。在六个月内进行了五次结果测量。这些测量包括：口服饮食（吞咽功能国际标准、国际吞咽障碍饮食标准）、功能性摄食（吞咽功能评估量表、多伦多床边吞咽筛查测试）、自我报告的吞咽相关生活质量（吞咽生活质量问卷），以及在唾液吞咽和张口任务期间，使用表面肌电图结合生物反馈评估的颏下肌肉力量和精确收缩。进行了混合效应模型和多元回归分析。参与者（N = 22，平均年龄73.9 ± 14.4岁，9名男性）在中风后平均2.8 ± 1.5天被招募。力量参数（用力吞咽命中率）在中风后十天至一个月之间有所改善（p = 0.04）。吞咽时间精确度在1至6个月之间显著提高（p < 0.01）。在六个月时，吞咽精确度下降的参与者生活质量也下降（p = 0.04），液体摄入时间增加（p = 0.002）。本研究是探索吞咽肌肉激活的力量和精确度参数的性质和演变及其对吞咽困难恢复影响的新举措。由于吞咽精确度与较差的功能结果相关，因此有必要进行进一步研究，以改善对慢性吞咽困难风险患者的早期鉴别诊断。
