Effect of diet variables on the biomechanical measures of swallowing in stroke patients

Abstract

This study was designed to examine the effect of diet variables, namely: bolus volume and consistency on the biomechanical measures of swallowing in stroke patients for better management of their oro-pharyngeal (O-P) dysphagia. Fifty patients with chronic and acute strokes were selected for the study. All patients were evaluated through an especially designed diagnostic protocol. Each subject was asked to swallow different bolus consistencies (thin and thick liquids; semisolid and solid) in different volumes (3, 5 and 10 ml). The biomechanical measures that were analysed from videofluoroscopic assessment of the patients include the following: (A) degree of impairment of the structural movement and bolus flow; (B) temporal measures of swallowing; (C) percent of O-P residue and percentage of the bolus penetrated/aspirated; (D) penetration/aspiration (P/A) scale; and (E) O-P Swallow Efficiency (OPSE) Score. The results demonstrated that the pharynx adapts itself to the increasing bolus volumes even in an impaired pharyngeal function. However, larger bolus volumes in both thin and thick liquids resulted in an increase in percentage of bolus P/A and higher P/A scale. The results also demonstrated that both thin and thick liquid consistencies were unsafe regarding the airway P/A and might better be avoided in the early stages of restoration of oral feeding in stroke patients. While on the other hand, semisolid consistency was the safest swallowed consistency in both patient groups. Presentation of calibrated bolus sizes and various consistencies should be an integral part of the swallow evaluation protocol. These evaluations will aid in choosing an appropriate nutritional option for patients with O-P dysphagia.