Highlights
- •Swallowing-related strength and skill were measured using a novel assessment.
- •Three groups were included in a cluster analysis: stroke, myopathic, and healthy.
- •Healthy and myopathic participants had homogeneous swallowing patterns.
- •We found 4 strength and skill subgroups within stroke patients with dysphagia.
- •Both strength and skill impairments may contribute to dysphagia after stroke.
Abstract
Objectives
To identify and characterize subgroups of stroke patients with clinical signs of dysphagia,
based on swallowing-related strength and skill impairments of the submental muscle
group.
Design
Prospective observational study.
Setting
Inpatient rehabilitation centers and community dwellings.
Participants
Individuals (N=114), including stroke patients with dysphagia (n=55) and 2 control
groups including myopathic patients with dysphagia (n=19) and healthy volunteers (n=40)
were included in this study.
Interventions
Not applicable.
Main Outcome Measures
Novel clinical assessment of strength (force generation) and skill (spatial and temporal
precision of muscle activation) of the submental muscle group during swallowing and
nonswallowing behaviors, using surface electromyography and dynamometry.
Results
Hierarchical cluster analysis revealed 4 clusters, which could be broadly characterized
as cluster 1: intact strength and skill, cluster 2: poor strength and poor nonswallowing
skill, cluster 3: poor strength, and cluster 4: poor strength and poor swallowing
skill. Membership in cluster was significantly associated with medical diagnosis (P<.001). The majority of healthy and myopathic participants were assigned to clusters
1 and 3, respectively, whereas stroke patients were found in all 4 clusters. Skill
outcome measures were more predictive of cluster assignment than strength measures.
Conclusions
Although healthy and myopathic participants demonstrated predominantly homogeneous
swallowing patterns of submental muscle function within their etiology, several subgroups
were identified within stroke, possibly reflecting different subtypes of swallowing
function. Future research should focus on the nature and rehabilitation needs of these
subtypes. Assessment of skill in swallowing may be an important but overlooked aspect
of rehabilitation.
Keywords
List of abbreviations:
sEMG (surface electromyography), TOMASS (Test of Masticating and Swallowing Solids), TWST (Timed Water Swallowing Test), VFSS (videofluoroscopic swallowing study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 17, 2020
Footnotes
Current affiliation for Ng, Laura Fergusson Brain Injury Trust, Christchurch, New Zealand.
Supported by the Commonwealth Scholarship and Fellowship Fund, a University of Canterbury Doctoral Scholarship, and a Post Graduate Publishing Bursary from the Canterbury Medical Research Foundation.
Disclosures: The commercial software used in this study (Biofeedback in Strength and Skill Training) was developed at the University of Canterbury Rose Centre for Stroke Recovery and Research and is owned by the University of Canterbury.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
