Swallowing Function and Kinematics in Stroke Patients with Tracheostomies.

Abstract

The purpose of this study was to compare the swallowing function and kinematics in stroke patients with and without tracheostomies. In this retrospective matched case-control study, we compared stroke patients with (TRACH group, n=24) and without (NO-TRACH group, n=24) tracheostomies. Patients were matched for age, sex, and stroke-type. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) and functional oral intake scale (FOIS) obtained from videofluoroscopic swallow study (VFSS) images. Swallowing kinematics were evaluated using a two-dimensional kinematic analysis of the VFSS images. Mean duration of tracheostomy was 132.38±150.46days in the TRACH group. There was no significant difference in the total VDS score between the TRACH (35.17±15.30) and NO-TRACH groups (29.25±16.66, p=0.247). FOIS was significantly lower in the TRACH group (2.33±1.40) than in the NO-TRACH group (4.33±1.79, p=0.001). The TRACH group had a significantly lower maximum vertical displacement (15.23±7.39mm, p=0.011) and velocity (54.99±29.59mm/s, p=0.011), and two-dimensional velocity (61.07±24.89mm/s, p=0.013) of the larynx than the NO-TRACH group (20.18±5.70mm, 82.23±37.30mm/s, and 84.40±36.05mm/s, respectively). Maximum horizontal velocity of the hyoid bone in the TRACH group (36.77±16.97mm/s) was also significantly lower than that in the NO-TRACH group (47.49±15.73mm/s, p=0.032). This study demonstrated that stroke patients with tracheostomies had inferior swallowing function and kinematics than those without tracheostomies. A prospective longitudinal study is needed to elucidate the effect of a tracheostomy on swallowing recovery in stroke patients.