Imaging swallowing dysfunction among patients recovering from severe traumatic brain injury

Abstract

Objective To explore the utility of videofluoroscopy in observing swallowing dysfunction after severe traumatic brain injury (TBI). Methods Videoflouroscopic studies of swallowing (VFSSs) were performed on 40 patients with severe TBI as well as 40 healthy matched controls.Information about penetration and aspiration was collected,and oral delay time (ODT),oral transit time (OTT),pharyngeal delay time (PDT),pharyngeal transit time (PTT) and the maximum vertical and anterior movement of hyoid bone were measured. Results Seventeen of the healthy controls (42.5％) displayed mild penetration,though none had severe penetration or aspiration.Among the severe TBI patients,5 ( 12.5％ ) displayed mild penetration,12 (30.0％) showed severe penetration and 17 (42.5％) subjects had aspiration.The 3ml liquid swallowing parameters of the severe TBI group were ODT ( 0.86 ± 0.37) s,OTT (0.73 ± 0.28 ) s,PDT ( 0.50 ± 0.35 ) s and PTT(0.61 ± 0.11 ) s.The maximum vertical hyoid bone movement in this group averaged (0.98 ± 0.38) cm,and maximum anterior movement was (0.37 ±0.37) cm.The healthy controls and severe TBI patients showed significant differences in terms of all six measures.Conclusion Dysphagia was found to be frequent among severe TBI patients,commonly occurring in the oral and pharyngeal phases.Videoflouroscopy may be helpful for identifying the main features of dysphagia and formulating better rehabilitation strategies. Key words: Traumatic brain injury; Dysphagia; Aspiration; Penetration; Videofluoroscopy; Swallowing