Abstract
Deglutitive aspiration is common after stroke, affecting up to 50% of patients and predisposing them to pneumonia, yet it is virtually impossible to predict those patients at greatest risk. The aim of this study was to develop a robust predictive model for aspiration after stroke. Swallowing was assessed by digital videofluoroscopy (VF) in 90 patients following hemispheric stroke. Lesion characteristics were determined by computerized tomography (CT) brain scan using the Alberta Stroke Programme Early CT Score (ASPECTS). Aspiration severity was measured using a validated penetration-aspiration scale. The probability of aspiration was then determined from measures of swallowing pathophysiology and lesion location by discriminant analysis. Aspiration was observed in 47 (52%) patients, yet despite disrupted swallowing physiology, intrasubject aspiration scores were variable. The best discriminant model combined pharyngeal transit time, swallow response time, and laryngeal closure duration to predict 73.11% of those aspirating (sensitivity = 66.54, specificity = 80.22, p > 0.001). The addition of lesion location did not add anything further to the predictive model. We conclude that the pathophysiology of poststroke aspiration is multifactorial but in most cases can be predicted by three key swallowing measurements. These measurements, if translatable into clinical bedside evaluation, may assist with the development of novel measurement and intervention techniques to detect and treat poststroke aspiration.
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References
Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN. Aspiration following stroke: clinical correlates and outcome. Neurology. 1988;38(9):1359–62.
Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry. 1989;52(2):236–41.
Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30(4):744–8.
Ding R, Logemann JA. Pneumonia in stroke patients: a retrospective study. Dysphagia. 2000;15(2):51–7.
Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001;16(1):7–18.
Linden P, Kuhlemeier KV, Patterson C. The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia. 1993;8(3):170–9.
Alberts MJ, Horner J, Gray L, Brazer SR. Aspiration after stroke: lesion analysis by brain MRI. Dysphagia. 1992;7(3):170–3.
Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia. 1999;14(2):85–92.
Daniels SK, Foundas AL. Lesion localization in acute stroke patients with risk of aspiration. J Neuroimaging. 1999;9(2):91–8.
Daniels SK, Foundas AL. The role of the insular cortex in dysphagia. Dysphagia. 1997;12(3):146–56.
Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85(2):938–50.
Miller AJ. In: Rosenbek JC, editor, The neuroscientific principles of swallowing and dysphagia. Dysphagia Series. San Diego, CA: Singular Publishing Group, 1999. p. 284.
Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol. 2001;22(8):1534–42.
Logemann JA. Manual for the videofluorographic study of swallowing. 2nd ed. Austin, TX: Pro-Ed; 1993.
Rosenbek JC, Robbins J, Roecker EB, Coyle MA, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.
Duda RO, Hart PE, Stork DG. Pattern classification. 2nd ed. New York: John Wiley and Sons; 2001.
Bland MJ, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.
Rademaker AW, Pauloski BR, Colangelo LA, Logemann JA. Age and volume effects on liquid swallowing function in normal women. J Speech Lang Hear Res. 1998;41(2):275–84.
Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78(2):141–6.
Martino R, Terrault N, Ezerzer F, Mikulis D, Diamant NE. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Gastroenterology. 2001;121(2):420–6.
Lazareck LJ, Moussavi ZM. Classification of normal and dysphagic swallows by acoustical means. IEEE Trans Biomed Eng. 2004;51(12):2103–12.
Vaiman M, Gabriel C, Eviatar E, Segal S. Surface electromyography of continuous drinking in healthy adults. Laryngoscope. 2005;115(1):68–73.
McKeown MJ, Torpey DC, Gehm WC. Non-invasive monitoring of functionally distinct muscle activations during swallowing. Clin Neurophysiol. 2002;113(3):354–66.
Fraser C, Power M, Hamdy S, Rothwell J, Hobday D, Hollander I, et al. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Neuron. 2002;34(5):831–40.
Acknowledgments
The authors thank Ms. L. Renaut (Radiography, Salford Royal Hospital) and Dr A. Vail (Statistician, University of Manchester) for their invaluable assistance.
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Power, M.L., Hamdy, S., Goulermas, J.Y. et al. Predicting Aspiration After Hemispheric Stroke from Timing Measures of Oropharyngeal Bolus Flow and Laryngeal Closure. Dysphagia 24, 257–264 (2009). https://doi.org/10.1007/s00455-008-9198-4
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DOI: https://doi.org/10.1007/s00455-008-9198-4