Aspiration In Stroke Patients Research Articles

Detecting Aspiration Risk in Stroke Patients Using the Water Swallow Test (WST)

Abstract Background The 3-ounce water swallow test (WST) is a widely used method during clinical (bed side) examination for screening of individuals who are at risk for oropharyngeal dysphagia and aspiration. Stroke represents the most frequent cause of neurological dysphagia. Aim of the Work The aim of this study is to detect the risk of aspiration in stroke patients using the 3-ounce water swallow test. Patients and Method This study included 40 stroke patients recruited from the Phoniatrics unit of Ain Shams University Hospitals. They were subjected to history taking, clinical assessment and the 3-ounce WST. Results The results of the 3-ounce Water Swallow Test showed that 18 (45%) patients had a positive test. Conclusion Almost half of participants are at risk of aspiration.

Validity & Reliability of a Korean-version of Eating Assessment Tool (K-EAT-10): Predicting the Risk of Aspiration in Stroke Patients

Objectives: This study aims to investigate the reliability and validity of a Korean version of the Eating Assessment Tool (EAT-10) as a clinical evaluation tool for dysphagia with stroke patients and determine its clinical usefulness as a screening tool. Methods: A total of 50 patients with stroke (15 without dysphagia, and 35 with dysphagia, identified through a videofluoroscopic swallowing study (VFSS) participated in this study. The internal consistency, test-retest reliability, and concurrent validity of the adapted Korean version of EAT-10(K-EAT-10) were evaluated. In addition, the K- EAT-10 scores were compared between two groups according to demographic characteristics, post-stroke conditions, and swallowing function. Moreover, K-EAT-10 scores were compared with the VFSS findings to estimate the sensitivity, specificity, and positive and negative predictions of aspiration. Results: The internal consistency of the K-EAT-10 questionnaire showed a Cronbach α coefficient of .091, and the correlation coefficient of the test- retest reliability was .988. In addition, when correlation analysis was performed between the total score of K-EAT-10 and the K-DHI, the correlation coefficient was .904. In the receiver operating characteristic (ROC) curve analysis of K-EAT-10, a cut-off point for the K-EAT-10 questionnaire was set at 10 points with a sensitivity of 86.7% and specificity of 77.1%, and the area under the curve was shown to be 0.86. In addition, the positive predictive value (PPV) for the K-EAT-10 was 91%, and the negative predictive value (NPV) was 60%. Conclusion: Korean version of EAT-10 revealed excellent internal consistency, test-retest reliability, concurrent validity and positive predictive value for aspiration. The results suggest that the Korean adaptation of EAT-10 can be useful as a clinical screening test for dysphagia, especially predicting aspiration risk in patients with stroke.

Utility of modified Mann assessment of swallowing ability (MMASA) in predicting aspiration risk and safe swallow in stroke patients.

Aspiration pneumonia is one of the commonest causes of post-stroke mortality. We may be able to reduce this morbidity and mortality by assessing the risk of aspiration in stroke patients. Assessment of this risk can be done using a physician-administered screening protocol to assess dysphagia. A score of ≥95 is a good cut off to detect patients who can take oral feeds safely. The primary objective was to predict aspiration risk using the Modified Mann Assessment Swallowing Ability (mMASA) scale. The secondary objective was to predict the safety of oral feeds using the same scale. An analytical cross-sectional study was conducted at a tertiary care rehabilitation centre in South India. A total of 100 stroke patients who underwent stroke rehabilitation in the study institution were divided into patients who were able to eat orally or not based on the mMASA scale. Demographic and stroke characteristics were recorded. The mMASA score was calculated and those with a score of ≥95 were given oral feeds. Those who scored <95 were given swallow therapy and re-evaluated in 2 weeks. Also, the mMASA score below which the patient was likely to develop aspiration pneumonia was detected using the receiver operating characteristic curve (ROC). Out of the 100 patients, 37 patients had a score of ≥95 and were started on oral feeds and had no complications; the rest were started on 2 weeks of swallow therapy. On re-evaluation after swallow therapy, 12 more were started on oral feeds. The remaining 51 patients did not reach the cut-off score of ≥95 and were continued on nasogastric tube feeding. A total of 11 patients developed features of aspiration pneumonia; all of them belonged to the group of 51 patients who consistently had a mMASA score <95. The ROC curve determined that a score of <89 was a good cut off to predict patients who are at high risk of aspiration. The scale can be used to predict the likelihood of aspiration and readiness to start oral feeds in sub-acute stroke patients.

The influence of pharyngeal width on post-stroke laryngeal aspiration.

Laryngeal penetration, which is a less serious form of aspiration, should be considered in patients with stroke to ensure early detection of risk of laryngeal aspiration and prevention of pneumonia. As a follow-up to a previous study that demonstrated the association of pharyngeal width to laryngeal aspiration, the present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with deglutition disorder following stroke. The pharyngeal width on the roentgenogram was measured and compared based on the severity of aspiration. Moreover, the optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. The pharyngeal width of the patients was wider than the controls. The increase of the pharyngeal width by aspiration severity was more evident in the patients with chronic and right cerebral stroke. The optimal cut-off point of the pharyngeal width was approximately 1 mm lesser for the prediction of penetration than for aspiration. The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients.

Criteria to assess tongue strength for predicting penetration and aspiration in patients with stroke having dysphagia.

Instrumental assessments are typically used to assess swallowing function in stroke patients with dysphagia, but these tests cannot be used for all patients or for continuous monitoring. Hence, an adjunctive method is necessary for screening patients who may require such tests. The purpose of this study was to analyze tongue strength with respect to the presence or absence of penetration and aspiration, using instrumental assessments, to provide a basis for clinical decision-making. Prospective observational study. University Hospitals in Gwangju, South Korea. Seventy-nine subjects with dysphagia underwent video fluoroscopic swallowing study (VFSS) and Iowa Oral Performance Instrument evaluations. VFSS results were assessed for the presence of penetration and aspiration, according to the penetration-aspiration scale. Receiver operating characteristic curve analysis was conducted with tongue strengths based on penetration and aspiration. During the swallowing of pureed, liquid, and solid foods, cut-off values of tongue strength for the anterior and posterior elevation and for the protrusion of tongue were suggested in cases of penetration and aspiration, among patients with dysphagia. These criteria had positive and negative predictive values of 54.6-90.2% and 57.5-96.9%, respectively. This study found that tongue strength has predictive abilities similar to clinical and bedside tests to screen penetration and aspiration in stroke patients with swallowing disorders. Therefore, it is a new screening test that clinical practitioners can choose to reduce the risk of pneumonia caused by post-stroke disorders. As a new screening tool, tongue strength can be combined with other clinical and instrumental assessments to predict penetration and aspiration in stroke patients with dysphagia.

Use of the maximal phonation test for the screening of dysphagia in stroke patients: a preliminary study.

Dysphagia is a commonly developed complication after stroke and may lead to pneumonia. Several screening tests for dysphagia have been introduced, but no consensus has been reached regarding the test that best detects dysphagia or swallowing difficulties. Maximum phonation time (MPT) can measure laryngeal and pharyngeal function indirectly by providing a means of assessing vocal cord integrity. Because vocal cords play a role in sound production and also protect the airways, we considered MPT might be used to screen for penetration and aspiration into airways in stroke patients. The purpose of this study was to investigate the ability of MPT to differentiate between stroke patients with or without penetration/aspiration and the relationships between MPT and videofluoroscopic swallowing study (VFSS) findings and those of other swallowing screening tests. Prospective observational study. Korean tertiary hospital. One hundred six Patients with acute stroke patients with suspected dysphagia referred for VFSS from January 2016 to December 2017. MPT differences among a normal group, a penetration group, and an aspiration group were analyzed, and correlations between MPT and age, Penetration Aspiration Scale (PAS), American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), Functional Dysphagia Scale (FDS) scores were investigated. MPTs were found to be significantly different in normal, penetration, and aspiration groups in stroke patients (P<0.01). Furthermore, MPT was highly correlated with PAS, ASHA-NOMS, and FDS scores. ROC analysis provided MPT cut off values for the presence of penetration and aspiration in stroke patients of 9.08 and 7.98 sec, respectively. In stroke patients, MPT could be used to detect penetration or aspirations while swallowing. and seems to have appropriate validity and sensitivity. MPT is proposed as a new screening tool for detecting dysphagia in stroke patients, especially airway aspiration.

Pharyngeal width and aspiration after stroke.

It is important to assess aspiration in stroke patients. The aim of this study was to develop a new additional tool to predict aspiration based on the pharyngeal width at rest in stroke patients with aspiration symptoms. The pharyngeal width was measured at the middle level of the second and third cervical vertebral bodies using a lateral neck roentgenogram in stroke patients and healthy controls. We named the average of the two pharyngeal widths as the JOSCYL width and calculated the 'JOSCYL width × 100 / neck circumference' as the JOSCYL scale. The correlation between the individual JOSCYL width, JOSCYL scale, and severity of dysphagia was analyzed in the stroke group using Spearman correlation analysis. The optimal cutoff point for predicting aspiration was determined by receiver-operating characteristic curve analysis of the JOSCYL width and JOSCYL scale. The JOSCYL width and JOSCYL scale of the stroke group were larger than those of the control group (P < 0.05). The correlation between the JOSCYL width, JOSCYL scale, and the severity of dysphagia was significant for the whole stroke group and the chronic stroke group (P < 0.05). The optimal cutoffs of the JOSCYL width and JOSCYL scale for predicting aspiration were approximately 18 mm and 50 in the stroke group. The JOSCYL width and JOSCYL scale are new indicators for predicting aspiration in stroke patients and are precise and easy to use. The accuracy of the JOSCYL width and JOSCYL scale for predicting aspiration was shown to be higher in the chronic stroke stage.

Temporal characteristics of laryngeal penetration and aspiration in stroke patients

Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. This study aimed to investigate the temporal characteristics of PA in post-stroke patients in terms of the timing of the PA event and hyolaryngeal incoordination. Fifty-eight swallows (38 stroke patients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters were compared between subgroups. Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P = 0.028), the time to maximal horizontal hyoid excursion (P = 0.010), and maximal epiglottic rotation (P = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P < 0.001). Pyriform sinus residue was observed significantly more often in the swallows with abnormal sequences (P = 0.030) than in the swallows with normal sequences. The timing of PA can be classified as before and during the swallow with significantly different temporal characteristics. The horizontal movement of hyoid is the most important factor associated with the pathophysiology of PA in stroke patients.

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases

Swallowing and Aspiration Risk: A Critical Review of Non Instrumental Bedside Screening Tests.

Background and PurposeThe presence of dysphagia and aspiration in stroke patients is associated with increased mortality and morbidity. Early recognition and management of these two conditions via reliable, minimally invasive bedside procedures before complications arise remains challenging in everyday clinical practice. This study reviews the available bedside screening tools for detecting swallowing status and aspiration risk in acute stroke by qualitatively observing reference population study design, clinical flexibility, reliability and applicability to acute-care settings.MethodsThe primary search was conducted using the PubMed, Embase, and Cochrane Library databases. The search was limited to papers on humans written in English and published from 1991 to 2016. Eligibility criteria included the consecutive enrollment of acute-stroke inpatients and the development of a protocol for screening aspiration risk during oral feeding in this population.ResultsOf the 652 sources identified, 75 articles were reviewed in full however, only 12 fulfilled the selection criteria. Notable deficiencies in most of the bedside screening protocols included poor methodological designs and inadequate predictive values for aspiration risk which render clinicians to be more conservative in making dietary recommendations.ConclusionsThe literature is dense with screening methods for assessing the presence of dysphagia but with low predictive value for aspiration risk after acute stroke. A standard, practical, and cost-effective screening tool that can be applied at the bedside and interpreted by a wide range of hospital personnel remains to be developed. This need is highlighted in settings where neither trained personnel in evaluating dysphagia nor clinical instrumentation procedures are available.

HUBUNGAN PELAKSANAAN SCREENING TEST MENELAN DENGAN KEJADIAN DISFAGIA PADA PASIEN BARU YANG MENDERITA STROKE AKUT

According to the NINDS 2015, States that a stroke occurs when the blood supply to brain fails suddenly interrupted due to a blockage or rupture of blood vessels were. Basic Health Research results that show an increase in the prevalence of stroke symptoms in Indonesia increased from 8.3 at 1000 in 2007 to 12.1 and at 1000 in 2013. One of the problems that arise due to stroke is a disorder of swallowing or dysphagia. According to the World Stroke Academy Learning Moduls in 2012 the prevalence of dysphagia in stroke sufferers range from 36 to 67%. In the year 2016 in RSSN dysphagia in stroke patients 22,94%. For early detection of dysphagia screening test required to swallow as a first step in identifying the risks due to dysphagia and aspiration in stroke patients. The purpose of this research is to know the relationship of the implementation of the screening test to swallow with dysphagia in acute stroke patients in the room just entered inpatient Neurology RSSN Bukittinggi in 2017. This research method using analytic, descriptive, then the data was processed using the Chi Square test. The sample in this study as many as 54 people respondents. Test result statistics retrieved value p value = 0.002 (p &lt; α) then it can be inferred the existence of a relationship between the implementation of the screening test to swallow with dysphagia in acute stroke patients the new entry. Analysis of the results obtained OR = 9.281 meaning respondents who perform screening test procedures in accordance with the swallow has a chance of 9.281 times in detecting the occurrence of dysphagia. Suggestions in this study is the implementation of a screening test this swallow can be included in SPO for nurses in Bukittinggi in the room especially RSSN Neurology in detecting the onset of dysphagia in acute stroke patients.

Reduced Maximum Pitch Elevation Predicts Silent Aspiration of Small Liquid Volumes in Stroke Patients.

Preliminary evidence has shown that reduced ability to maximally raise vocal pitch correlates with the occurrence of aspiration (i.e., airway invasion by food or liquid). However, it is unclear if this simple task can be used as a reliable predictor of aspiration in stroke patients. Our aim was to examine whether maximum vocal pitch elevation predicted airway invasion and dysphagia in stroke. Forty-five consecutive stroke patients (<1 month poststroke) at a rehabilitation setting participated in a videofluoroscopic swallow study and two maximum vocal pitch elevation tasks. Maximum pitch was evaluated acoustically [maximum fundamental frequency (max F0)] and perceptually. Swallowing safety was rated using the Penetration/Aspiration Scale and swallowing performance was assessed using components of the Modified Barium Swallow Impairment Profile (MBSImPTM©). Data were analyzed using simple regression and receiver operating characteristics curves to test the sensitivity and specificity of max F0 in predicting aspiration. Correlations between max F0 and MBSImP variables were also examined. Max F0 predicted silent aspiration of small liquid volumes with 80% sensitivity and 65% specificity (p = 0.023; area under the curve: 0.815; cutoff value of 359.03 Hz). Max F0 did not predict non-silent aspiration or penetration in this sample and did not significantly correlate with MBSImP variables. Furthermore, all participants who aspirated silently on small liquid volumes (11% of sample) had suffered cortical or subcortical lesions. In stroke patients (<1 month poststroke), reduced maximum pitch elevation predicts silent aspiration of small liquid volumes with high sensitivity and moderate specificity. Future large-scale studies focusing on further validating this finding and exploring the value of this simple and non-invasive tool as part of a dysphagia screening are warranted.

Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

Background: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO₂) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO₂ ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO₂ measurements for the evaluation of aspiration risk in acute stroke patients. Methods: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO₂ was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. Results: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO₂ (mean SpO₂ without aspiration 95.54 ± 2.7% vs. mean SpO₂ with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO₂ levels. Conclusions: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia.

Background/AimsWe attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES), and to identify the risk factors for aspiration.MethodsWe performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, and nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student’s t test.ResultsThree (8.3%) and 4 (11.1%) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in the pyriform sinus were significantly lower than those in patients without residue in the pyriform sinus (P < 0.05). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration (P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (OR, 0.03; 95% CI, 0.01–0.65; P < 0.05).ConclusionsManometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS, and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration.

Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study.

[Purpose] The purpose of this study was to investigate the effect of jaw opening exercise (JOE) on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three subjects were recruited. Isometric and isotonic JOE were performed using a rubber ball, 5 days a week for 4 weeks. Aspiration was evaluated using the penetration-a spiration scale (PAS) based on a videofluoroscopic swallowing study. [Results] All subjects showed a score reduction of at least 1 point and a maximum reduction of 2 points in the PAS in the liquid type. [Conclusion] This study confirmed that JOE can be used to reduce aspiration in patients with dysphagia after stroke.

Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients.

The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients. The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before. A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies. Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015. This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies. There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test. This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.

Lesion Location Predicts Transient and Extended Risk of Aspiration After Supratentorial Ischemic Stroke

To assess the association of lesion location and risk of aspiration and to establish predictors of transient versus extended risk of aspiration after supratentorial ischemic stroke. Atlas-based localization analysis was performed in consecutive patients with MRI-proven first-time acute supratentorial ischemic stroke. Standardized swallowing assessment was carried out within 8±18 hours and 7.8±1.2 days after admission. In a prospective, longitudinal analysis, 34 of 94 patients (36%) were classified as having acute risk of aspiration, which was extended (≥7 days) or transient (<7 days) in 17 cases. There were no between-group differences in age, sex, cause of stroke, risk factors, prestroke disability, lesion side, or the degree of age-related white-matter changes. Correcting for stroke volume and National Institutes of Health Stroke Scale with a multiple logistic regression model, significant adjusted odds ratios in favor of acute risk of aspiration were demonstrated for the internal capsule (adjusted odds ratio, 6.2; P<0.002) and the insular cortex (adjusted odds ratio, 4.8; P<0.003). In a multivariate model of extended versus transient risk of aspiration, combined lesions of the frontal operculum and insular cortex was the only significant independent predictor of poor recovery (adjusted odds ratio, 33.8; P<0.008). Lesions of the insular cortex and the internal capsule are significantly associated with acute risk of aspiration after stroke. Combined ischemic infarctions of the frontal operculum and the insular cortex are likely to cause extended risk of aspiration in stroke patients, whereas risk of aspiration tends to be transient in subcortical stroke.

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

Background and Purpose: The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. Methods: We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. Results: We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. Conclusions: WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.

Longitudinal Changes of the Swallowing Process in Subacute Stroke Patients with Aspiration

The purpose of this study was to evaluate longitudinal changes of the swallowing process in stroke patients with aspiration using kinematic analysis. Twenty-eight subacute stroke patients with aspiration on fluid at initial videofluoroscopic swallowing studies (VFSS) were included. Follow-up VFSS was performed at 2-4 weeks after initial studies that were conducted at an average of 26 days after stroke. Temporal and spatial variables were calculated by two-dimensional motion analysis of hyoid bone and epiglottic movements. Swallowing process delays associated with hyoid bone and epiglottic movements were improved at follow-up studies, whereas spatial variables were not. Fourteen patients had recovered from aspiration at follow-up. Time to the start of the hyoid movement was longer in the nonrecovered patient group at initial studies (1.76 ± 1.07 s) than in the recovered group (0.90 ± 0.82 s, P=0.024). Although time-associated differences between the nonrecovered and recovered groups disappeared at follow-up studies, aspiration persisted in the nonrecovered group. This study shows that recovery from delays in the swallowing process is a conspicuous change during the subacute stage in stroke patients with aspiration. Our findings suggest that delayed swallowing triggering at initial VFSS is a useful predictor of poor recovery from aspiration in stroke patients.

Does Arterial Oxygen Desaturation as Measured by Pulse Oximetry Occur During Aspiration or Penetration in Acute Dysphagic Stroke Patients?

Background: The high prevalence of swallowing problems and aspiration in stroke patients has been well documented. A reliable swallowing assessment that can accurately determine potential aspiration risk is necessary. The most recent adjunct to the clinical bedside assessment has been the use of pulse oximetry. Purpose: This study examines whether the use of oxygen saturation levels as measured by pulse oximetry can reliably predict the presence of aspiration or penetration of acute dysphagic stroke patients. Methods: This prospective study compared results of pulse oximetry in 20 people with dysphagia post stroke with normal controls. Fiberoptic Endoscopic Evaluation of the Swallow (FEES) was used to confirm the presence of aspiration or penetration. The FEES and pulse oximetry readings were taken simultaneously. Investigators evaluated the results of each test independently to avoid bias. Results: The results confirmed that saturation levels are lower in people with dysphagia post stroke than in the nondysphagic control group. No systematic relations between saturation levels and episodes of aspiration or penetration were found for any of the consistencies tested. Clinically significant changes in oxygen saturation are not found to predict risk of aspiration or penetration in the patient group. Measures of sensitivity (23.5%) and specificity (33.3%) are low. Conclusions: The results confirm that oxygen saturation as measured by pulse oximetry is not a reliable screening tool for identifying aspiration risk in acute stroke patients.