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Classification of Stroke Patients With Dysphagia Into Subgroups Based on Patterns of Submental Muscle Strength and Skill Impairment

  • Karen B. Ng
    Correspondence
    Corresponding author Karen Ng, PhD, The University of Canterbury Rose Centre for Stroke Recovery and Research, Leinster Chambers, Level One, 249 Papanui Road, Merivale, Christchurch 8140 New Zealand.
    Affiliations
    University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand

    School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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  • Richard D. Jones
    Affiliations
    University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand

    School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand

    Department of Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand

    New Zealand Brain Research Institute, Christchurch, New Zealand

    Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
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  • Esther Guiu Hernandez
    Affiliations
    University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand

    School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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  • Phoebe Macrae
    Affiliations
    University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand

    School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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  • Maggie-Lee Huckabee
    Affiliations
    University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand

    School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
    Search for articles by this author
Published:December 17, 2020DOI:https://doi.org/10.1016/j.apmr.2020.11.014

      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)
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