Deglutitive laryngeal closure in aspirating stroke patients
Abstract
Background: Prevalence of dysphagia has been reported in up to 70% of stroke patients, predisposing them to aspiration and pneumonia. Despite this, the mechanism for aspiration remains unclear. Aims: Determine the relationship between bolus flow and laryngeal closure during swallowing in stroke patients and examine the sensorimotor mechanisms leading to aspiration. Methods: Measures of swallowing and bolus flow were taken from digital videofluoroscopic images in 90 stroke patients and 50 healthy adults, following repeated volitional swallows of controlled volumes of thin liquid. Aspiration was assessed using a validated penetration-aspiration scale. Oral sensation was also measured by electrical stimulation at the faucial pillars (FP). Results: After stroke laryngeal ascent was delayed (0.31 +/-0.06s, p<0.001) resulting in prolongation of pharyngeal transit time (1.17+/-0.07s, p< 0.001) without a concomitant increase in laryngeal closure duration (0.84+/-0.04s, p=0.9). The delay in laryngeal elevation correlated with both aspiration severity (r=0.5, p<0.001) and oral sensation (r=0.5, p<0.001). Conclusions: After stroke, duration of laryngeal delay and degree of sensory deficit are associated with aspiration severity. These findings indicate a role for sensorimotor interactions in control of swallowing and have implications for assessment and management of post stroke dysphagia
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