Brain Neurorehabil.  2014 Mar;7(1):54-60. 10.12786/bn.2014.7.1.54.

Association between Location of Brain Lesion and Clinical Factors and Findings of Videofluoroscopic Swallowing Study in Subacute Stroke Patients

• Jeon WH
• Park GW
• Lee JH
• Jeong HJ
• Sim YJ

• KMID: 1914560
• DOI: http://doi.org/10.12786/bn.2014.7.1.54

Abstract

OBJECTIVE
To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. METHOD: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review.
RESULTS
A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion.
CONCLUSION
Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions.

Keyword

brain stem; dysphagia; stroke

MeSH Terms

Activities of Daily Living
Aphasia
Brain Stem
Brain*
Deglutition Disorders
Deglutition*
Humans
Pyriform Sinus
Retrospective Studies
Stroke*

Reference

1. Paik NJ, Kim IS, Kim JH, Oh BM, Han TR. Clinical validity of the functional dysphagia scale based on videofluoroscopic swallowing study. J Korean Acad Rehabil Med. 2005; 29:43–49.

2. Roth EJ. Medical complications encountered in stroke rehabilitation. Phys Med Rehabil Clin North Am. 1991; 2:563–578.

3. Smithard DG, O'Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The natural history of dysphagia following a stroke. Dysphagia. 1997; 12:188–193.

4. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999; 30:744–748.

5. Lee CK, Kim JA. Pattern of post-stroke swallowing disorder according to the brain lesion. J Korean Acad Rehabil Med. 2001; 25:193–201.

6. Martin RE, Sessle MDS. The role of the cerebral cortex in swallowing. Dysphagia. 1993; 8:195–202.

7. Robbins J, Levin RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988; 3:11–17.

8. Robbins J, Levin RL, Maser A, Rosenbeck JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993; 74:1295–1300.

9. Alberts MJ, Horner J, Gray L, Brazer SR. Aspiration after stroke: lesion analysis by brain MRI. Dysphagia. 1992; 7:170–173.

10. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, Kim SH, Kim TH, Han TR. Development of the Korean Version of Modified Barthel Index (K-MBI): multicenter study for subjects with stroke. J Korean Acad Rehabil Med. 2007; 31:283–297.

11. Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE. Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. 1979; 60:14–17.

12. Kim SJ, Park YH. Comparison of sensitivity of neurobehavioral cognitive status examination and minimental state examination. J Korean Acad Rehabil Med. 1997; 21:1105–1109.

13. Kohn R, Vicente B, Rioseco P, Saldivia S, Torres S. The mini-mental state examination: age and education distribution for a Latin American population. Aging Ment Health. 2008; 12:66–71.

14. Mungas D, Marshall SC, Weldon M, Haan M, Reed BR. Age and education correction of Mini-Mental State Examination for English and Spanish-speaking elderly. Neurology. 1996; 46:700–706.

15. Logemann JA. Swallowing physiology and pathophysiology. Otolaryngol Clin North Am. 1988; 21:613–623.

16. Jung SH, Lee KJ, Hong JB, Han TR. Validation of clinical dysphagia scale: based on videofluoroscopic swallowing study. J Korean Acad Rehabil Med. 2005; 29:343–350.

17. Horner J. Managing dysphagia. Dysphagia. 1991; 89:203–213.

18. Meadows JC. Dysphagia in unilateral cerebral lesions. J Neurol Neurosurg Psychiatry. 1973; 36:853–860.

19. Gordon C, Langton Hewer R, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed). 1987; 295:411–414.

20. Knowles C, Selly W. Relearning to swallow after a stroke. Nursing Times. 1988; 84:46–47.

21. Daniels SK, Foundas AL. Lesion localization in acute stroke patients with risk of aspiration. J Neuroimaging. 1999; 9:91–98.

22. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, Pedace C, Lenzi L. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009; 18:329–335.

23. Langdon PC, Lee AH, Binns CW. Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. J Clin Neurosci. 2007; 14:630–634.

24. Broadley S, Croser D, Cottrell J, Creevy M, Teo E, Yiu D, Pathi R, Taylor J, Thompson PD. Predictors of prolonged dysphagia following acute stroke. J Clin Neurosci. 2003; 10:300–305.

25. Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL. Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev. 2006; 43:301–310.

26. Achem SR, Devault KR. Dysphagia in aging. J Clin Gastroenterol. 2005; 39:357–371.