Comparison of Sequential Swallowing in Patients With Acute Stroke and Healthy Adults

Abstract 

Murguia M, Corey DM, Daniels SK. Comparison of sequential swallowing in patients with acute stroke and healthy adults.

Objectives

To compare hyolaryngeal complex (HLC) movement and leading-edge-of-the-bolus location patterns of sequential swallowing in patients with stroke and healthy adults, and to determine whether these patterns affect swallowing safety.

Design

Between-groups comparison.

Setting

Veterans hospital.

Participants

Consecutively admitted patients with acute unilateral supratentorial stroke (right hemisphere damage, n=13; left hemisphere damage, n=16) and age-matched healthy participants (n=25).

Interventions

Not applicable.

Main Outcome Measures

HLC movement pattern, bolus location, Penetration-Aspiration (P-A) Scale score.

Results

No significant group differences were observed for HLC movement pattern, bolus location, and P-A Scale score. Specific HLC movement patterns and bolus location were not associated with a higher P-A Scale score. A significant correlation between HLC movement pattern and bolus location was observed. Bolus location was typically inferior to the valleculae between swallows when the HLC was partially elevated. Across all groups, P-A Scale scores were significantly higher during sequential swallowing than single swallows.

Conclusions

HLC movement pattern and bolus location do not appear related to airway invasion, at least in persons without significant dysphagia. Given higher P-A Scale scores during sequential swallowing as compared with single swallows, sequential swallowing should always be evaluated in all patients.

Key Words: Cerebrovascular disorders, Deglutition, Deglutition disorders, Rehabilitation

List of Abbreviations: ANOVA, analysis of variance, HLC, hyolaryngeal complex, LHD, left hemisphere damage, MRI, magnetic resonance imaging, NIHSS, National Institutes of Health Stroke Scale, P-A, penetration-aspiration, RHD, right hemisphere damage