Abstract
Mastication and food consistency each affect the passage of food through the oral cavity and pharynx and its coordination with swallow initiation. Since hemispheric stroke may damage cortico-medullary neural pathways, we hypothesized that it could also alter the coordination of eating and swallowing. Using videofluorography, we studied 30 individuals with hemispheric stroke and 27 age-matched controls as they consumed liquid barium, corned beef hash, or a combination of liquid and solid (two-phase) food. We tracked the leading edge of the barium during feeding and at swallow onset in relation to occurrences of laryngeal penetration and aspiration. Compared with asymptomatic controls, the leading edge remained in the hypopharynx before swallowing longer in stroke subjects (P = 0.016) and was lower in the foodway at swallow onset with two-phase food (P = 0.03) and liquid (P = 0.06). Penetration-aspiration scores were significantly higher for liquid and two-phase ingesta when the leading edge was deeper in the pharynx at swallow onset (P = 0.03). These findings suggest that stroke alters the coordination of bolus transport and swallowing, particularly with foods containing a liquid phase. With such an impairment, a bolus may enter the hypopharynx prematurely, thus increasing the risk of aspiration.
Highlights
Dysphagia is common following hemispheric stroke [1]
The specific mechanism of swallowing dysfunction after unilateral hemispheric stroke remains unclear, studies suggest that hemispheric stroke likely damages the neural pathways from the cerebral cortex to the medullary swallowing centers [6,7]
We found that PA scale scores were significantly higher when the leading edge reached the floor of the piriform sinus before swallow onset
Summary
Dysphagia is common following hemispheric stroke [1]. The incidence of dysphagia in stroke survivors ranges from approximately 30% when evaluated by screening to up to 70% using instrumental assessments [2,3,4,5]. The specific mechanism of swallowing dysfunction after unilateral hemispheric stroke remains unclear, studies suggest that hemispheric stroke likely damages the neural pathways from the cerebral cortex to the medullary swallowing centers [6,7]. Damage to neural pathways may hamper motor control of oral and pharyngeal structures or alter their afferent inputs. Swallowing impairments due to stroke include reduced lingual control, delayed swallowing reflex, reduced pharyngeal peristalsis, and oropharyngeal sensory deficits [8,9,10,11,12]. These dysfunctions are suspected contributors to the occurrence of aspiration
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
