Functional Dysphagia Scale Scores Research Articles

Comparative Analysis of the Prevalence of Dysphagia in Patients with Mild COVID-19 and Those with Aspiration Pneumonia Alone: Findings of the Videofluoroscopic Swallowing Study.

Background and Objectives: Patients recovering from mild coronavirus disease (COVID-19) reportedly have dysphagia or difficulty in swallowing. We compared the prevalence of dysphagia between patients diagnosed with mild COVID-19 and those diagnosed with aspiration pneumonia alone. Materials and Methods: A retrospective study was conducted from January 2020 to June 2023 in 160 patients referred for a videofluoroscopic swallowing study (VFSS) to assess for dysphagia. The cohort included 24 patients with mild COVID-19 and aspiration pneumonia, 30 with mild COVID-19 without aspiration pneumonia, and 106 with aspiration pneumonia alone. We reviewed the demographic data, comorbidities, and VFSS results using the penetration-aspiration scale (PAS) and functional dysphagia scale (FDS). Results: In a study comparing patients with mild COVID-19 (Group A) and those with aspiration pneumonia alone (Group B), no significant differences were observed in the baseline characteristics, including the prevalence of dysphagia-related comorbidities between the groups. Group A showed milder dysphagia, as evidenced by lower PAS and FDS scores, shorter oral and pharyngeal transit times (p = 0.001 and p = 0.003, respectively), and fewer residues in the vallecula and pyriform sinuses (p < 0.001 and p < 0.03, respectively). When Group A was subdivided into those with COVID-19 with (Group A1) and without aspiration pneumonia (Group A2), both subgroups outperformed Group B in terms of specific VFSS metrics, such as oral transit time (p = 0.01), pharyngeal transit time (p = 0.04 and p = 0.02, respectively), and residue in the vallecula (p = 0.04 and p = 0.02, respectively). However, Group B showed improved triggering of the pharyngeal swallowing reflex compared with Group A2 (p = 0.02). Conclusion: Mild COVID-19 patients showed less severe dysphagia than those with aspiration pneumonia alone. This finding was consistent across VFSS parameters, even when the COVID-19 group was subdivided based on the status of aspiration pneumonia.

High-Frequency Cerebellar rTMS Improves the Swallowing Function of Patients with Dysphagia after Brainstem Stroke.

Objective To explore the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the swallowing motor area of the cerebellum in patients with dysphagia after brainstem stroke. Methods A total of 36 patients with dysphagia after brainstem stroke were recruited and divided into 3 groups. Before stimulation, single-pulse transcranial magnetic stimulation (TMS) was used to determine the swallowing dominant cerebellar hemisphere and the representation of the mylohyoid muscle. The three groups of patients received bilateral cerebellar sham stimulation, dominant cerebellar rTMS + contralateral sham stimulation, or bilateral cerebellar rTMS. The stimulus plan for each side was 10 Hz, 80% resting movement threshold (rMT), 250 pulses, 1 s per stimulus, and 9 s intervals. Sham rTMS was performed with the coil held at 90° to the scalp. The changes in the motor evoked potential (MEP) amplitude and the clinical swallowing function scales of the patients after stimulation were compared among the three groups. Results 34 patients were finally included for statistical analysis. The scores of penetration aspiration scale (PAS) and functional dysphagia scale (FDS) of the patients after 2 weeks of rTMS in the unilateral stimulation group and bilateral stimulation group were better than that in the sham stimulation group, and there was no significant difference between the two groups. The increase in the MEP amplitude of the cerebral hemisphere in the bilateral stimulation group was higher than that in the other two groups, and the increase in the MEP amplitude in the unilateral stimulation group was higher than that in sham stimulation group. There was no correlation between the improvement in patients' clinical swallowing function (PAS scores and FDS scores) and the increase in MEP amplitude in either the unilateral stimulation group or the bilateral stimulation group. Conclusion High-frequency rTMS in the cerebellum can improve swallowing function in PSD patients and increase the excitability of the representation of swallowing in the bilateral cerebral hemispheres. Compared with unilateral cerebellar rTMS, bilateral stimulation increased the excitability of the cerebral swallowing cortex more significantly, but there was no significant difference in clinical swallowing function.

Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke.

Background Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, P < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, P < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = −1.04, 95% CI -1.50 to -0.58, P < 0.05), the penetration-aspiration scale (PAS) score (SMD = −0.85, 95% CI -1.33 to -0.36, P < 0.05), and the functional dysphagia scale score (SMD = −1.05, 95% CI -1.48 to -0.62, P < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (P = 0.52) > tDCS (P = 0.48), the best probabilistic ranking of the SSA score is rTMS (P = 0.72) > tDCS (P = 0.28), and the best probabilistic ranking of the PAS score is rTMS (P = 0.68) > tDCS (P = 0.32). Conclusion Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.

Postoperative Dysphagia Aortica: Comparison with Other Dysphagia.

Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.

Comparison of straw and cup for liquid swallowing in poststroke patients.

The purposes of this study were to compare poststroke liquid swallowing methods by including a cup and a straw in videofluoroscopic swallowing studies (VFSS) and to test the hypothesis that increased aspiration would be observed with the cup compared to the straw. Eighty-five poststroke patients who had undergone VFSS using a spoon, cup, and straw were included. Penetration-aspiration scale and functional dysphagia scale (FDS) were used for assessment. These scores did not differ significantly between the cup and the straw. Higher FDS scores were found with the cup than with the straw in patients who had penetration/aspiration with both the cup and the straw and with the cup only. However, FDS scores did not differ significantly between the cup and the straw in patients who had penetration/aspiration with the straw only. Although advantages of the straw over the cup were clear, some patients showed penetration/aspiration only with the straw.

Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke.

ObjectiveTo investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.MethodsThis study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.ResultsThere were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.ConclusionIn patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.

Optimal placement of electrodes for treatment of post-stroke dysphagia by neuromuscular electrical stimulation combined with effortful swallowing.

We aimed to determine the optimal placement of electrodes for neuromuscular electrical stimulation (NMES) for post-stroke dysphagia therapy. 31 patients with post-stroke dysphagia were randomised to three groups according to NMES electrode placement. In Group A (n = 10), two pairs of electrodes were attached horizontally on the suprahyoid and infrahyoid muscles. In Group B (n = 11), one pair of electrodes was attached horizontally on the suprahyoid muscles while the other was attached vertically on the infrahyoid muscles. In Group C (n = 10), the electrodes were attached vertically, with one pair above the hyoid bone and the other above the cricoid cartilage. All patients received rehabilitation treatment via NMES combined with effortful swallowing training five times weekly for four weeks. The effect of NMES electrode placement was assessed in terms of the Functional Dysphagia Scale (FDS) and Dysphagia Outcome and Severity Scale (DOSS) scores. Group A showed significantly greater improvement than Group B in overall FDS (p = 0.009) and pharyngeal-phase FDS (FDS-P; p = 0.005) scores. Group A also showed significant improvement when compared with Group C in overall FDS (p = 0.001) and FDS-P (p = 0.001) scores. Horizontal placement of the NMES electrodes on the suprahyoid and infrahyoid muscles for the treatment of post-stroke dysphagia by NMES combined with effortful swallowing was more effective than the horizontal and vertical placement of electrodes on the suprahyoid and infrahyoid muscles, respectively, and their vertical placement above the hyoid bone and cricoid cartilage.

Combined Effects of NMES and Mendelsohn Maneuver on the Swallowing Function and Swallowing-Quality of Life of Patients with Stroke-Induced Sub-Acute Swallowing Disorders.

It is necessary to identify how to improve the swallowing-related quality of life, as well as the swallowing function, in order to evaluate the effect of treatments on swallowing disorders. This study aimed to prove the effects of a compound swallowing intervention (Mendelsohn maneuver + neuromuscular electrical stimulation (NMES)) on the swallowing function and the quality of life by applying the compound swallowing intervention to patients with sub-acute swallowing disorders due to cerebral infarction for eight weeks. This study analyzed 43 subjects who were diagnosed with swallowing disorders due to cerebral infarction. The experiment consisted of the Mendelsohn maneuver treatment group (n = 15), the NMES treatment group (n = 13), the compound intervention group (Mendelsohn maneuver + NMES; n = 15). The results of ANCOVA showed that the changes in Functional Dysphagia Scale (FDS) scores and Swallowing–Quality of Life (SWAL–QOL) score were different among groups. The compound intervention group had the highest FDS scores and SWAL–QOL score followed by Mendelsohn, and the NMES group had the lowest. The result of this study suggests that NMES can be more effective when it is combined with a traditional swallowing rehabilitation therapy rather than a single intervention method.

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

Background/AimsThis study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).MethodsThis study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS.ResultsThe Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score.ConclusionsThe severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

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.

Effective electrical stimulation placement combined with effortful swallowing maneuver for post-stroke dysphagia therapy

The objective of this study is to evaluate which type of neuromuscular electrical stimulation (NMES) electrode placement is more effective for post-stroke dysphagia therapy. Thirty-one post-stroke dysphagic patients were randomly divided into the three groups according to NMES electrode placement types; in group A ( n = 10), both pair of electrodes were horizontally attached on the suprahyoid muscles above the hyoid bone and on the infrahyoid muscles below it, in group B ( n = 11), each pair of electrodes was horizontally and vertically attached on the suprahyoid muscles above the hyoid bone and on the infrahyoid muscles below it, and in group C ( n = 10), both pair of electrodes were vertically attached across the hyoid bone above the thyroid notch and across the cricoid cartilage below the thyroid cartilage. All patients received NMES combined with effortful swallowing maneuver five times a week for a 4-week period as rehabilitation treatment. The effect of NMES electrode placement was assessed by comparing functional dysphagia scale (FDS) and dysphagia outcome and severity scale (DOSS) scores about thin liquid swallowing at the initial videofluoroscopic swallowing study (VFSS) and the follow-up VFSS after intervention. Additionally, FDS scores were categorized into oral phase (FDS-O) and pharyngeal phase (FDS-P). Significant improvement of FDS and DOSS scores was observed in all three types of electrode placements. However, only group A electrode placement showed significant difference in FDS and FDS-P scores compared to group B and group C after the intervention. The group A electrode placement was significantly more effective than other electrode placements in NMES therapy for post-stroke dysphagia patients.

The correlation between SWAL-QOL outcome and functional dysphagia scale in stroke patients

There were some reports about Swallowing Quality of Life (SWAL-QOL), however still insufficient in stroke patients. This study is to evaluate the impact of dysphagia on quality of life in stroke patients by demonstrating the correlation between Swallowing Quality of Life questionnaire outcome and Functional Dysphagia Scale (FDS) score. Sixty-one stroke patients with dysphagia were enrolled. To evaluate for patients with cognitive impairment, we used the modified SWAL-QOL questionnaire for caregiver. We performed comparative analysis between the modified SWAL-QOL score of nasogastric tube feeding patients and that of oral feeding patients ( Table 1 ). The severity of dysphagia was assessed by FDS according to the result of VFSS. We investigated the correlation between the modified SWAL-QOL score and the FDS score. When using the modified SWAL-QOL, the mean score of tube feeding group was 107.59 ± 17.04, which of oral feeding group score was 112.21 ± 20.08 ( Table 2 ). A significant difference between two groups was showed in burden and sleep domains respectively ( P = 0.012, P = 0.003). There was no significant difference in total score of modified SWAL-QOL between two groups ( P = 0.345). There was a significant inverse correlation between the total score of SWAL-QOL outcome and that of total FDS score ( r = -0.465, P = 0.000). The pharyngeal phase score of FDS was significantly correlated with burden ( r = −0.361, P = 0.004), mental health ( r = −0.364, P = 0.004), social functioning ( r = −0.307, P = 0.016) and symptom frequency ( r = −0.367, P = 0.004) domains of SWAL–QOL ( Table 3 ). We think it needs to assess the SWAL-QOL in stroke patients with dysphagia and should focus the rehabilitation of pharyngeal phase to promote better patient's quality of life.

Comparison of dysphagia outcomes between rostral and caudal lateral medullary infarct patients

ABSTRACTObjective: A detailed knowledge of dysphagia outcomes in lateral medullary infarct (LMI) patients would enable proper establishment of swallowing therapy goals and strategies. However, little is known about the impact of infarct location on dysphagia outcomes in patients with LMI. Methods: Twenty patients with rostral LMI (rostral group) and 20 patients with caudal LMI (caudal group) participated in the study. All patients underwent swallowing therapy, which included compensatory treatments and strengthening exercises, for >3 months. Dysphagia evaluation was performed twice (during the subacute stage and six months after stroke onset) using videofluoroscopic swallowing studies. Dysphagia degree was assessed using the functional dysphagia scale (FDS), the penetration–aspiration scale (PAS) and the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale. Results: In the subacute stage, the rostral group had significantly higher FDS and PAS scores and a significantly lower ASHA NOMS score than the caudal group. Patients from both groups showed significant improvement from the initial evaluation to the six-month evaluation. There were no significant differences in these scale scores between the two groups at the six-month evaluation. Conclusion: In the subacute stage, patients in the rostral group had more severe dysphagia than those in the caudal group. Dysphagia improved in both groups after 3–6 months of swallowing therapy. At six months after onset, there were no significant differences in dysphagia severity between the two groups. Recovery from dysphagia after LMI was observed regardless of the infarct location.

Efficacy of Predicting Videofluoroscopic Results in Dysphagic Patients with Severe Cerebral Palsy Using the Mann Assessment of Swallowing Ability.

The aim of this study was to evaluate the efficacy of the Mann Assessment of Swallowing Ability (MASA) to predict the results of videofluoroscopic swallowing studies. Children with cerebral palsy with suspicion of aspiration were enrolled. The Functional Dysphagia Scale (FDS) was used to quantify the swallowing dysfunction in videofluoroscopic swallowing studies. Correlation between MASA and FDS scores and differences in these two scores between aspirators and nonaspirators and between silent and overt aspirators were analyzed. Sixteen patients, level IV or V according the Gross Motor Function Classification System, were included. Thirteen patients (81.3%) had aspiration, and 9 (69.2%) were silent aspirators. The MASA scores between aspirators and nonaspirators were not different (median values of total scores, 107.0 and 94.0). The aspirators had higher FDS pharyngeal subtotal scores (P = 0.024) and slightly higher total FDS scores (P = 0.059). The differences in these two scales between silent and overt aspirators were not significant. Correlation coefficients between oral phase subtotal FDS scores and MASA subtotal scores in oral preparation, oral phase, and oral phase total were -0.713 (P < 0.05), -0.428 (P = 0.098), and -0.665 (P < 0.05), respectively. No correlation was found between the pharyngeal subtotal scores in these two scales. MASA was not useful in differentiating aspirators and nonaspirators and between silent and overt aspirators in severely disabled cerebral palsy, but it could predict oral dysfunction in videofluoroscopic swallowing studies.

Effect of Electrical Stimulation of the Suprahyoid Muscles in Brain-Injured Patients with Dysphagia.

The purpose of this study is to determine whether neuromuscular electrical stimulation of the suprahyoid muscle is effective compared to that of the infrahyoid muscle in brain-injured patients with dysphagia. A total of 132 patients with stroke, traumatic brain injury, or brain tumor in 2 university hospitals were allocated to 2 groups: those who received electrical stimulation therapy (EST) on the suprahyoid muscles (SM group, n = 66) and those who received EST with one pair of electrodes on the suprahyoid muscle and the other pair on the infrahyoid muscle (SI group, n = 66). Patients received 11.2 ± 3.4 sessions of electrical stimulation in the SM group and 11.9 ± 3.4 sessions in the SI group. The functional dysphagia scale (FDS), swallow function score (SFS), supraglottic penetration, and subglottic aspiration were measured using videofluoroscopic swallowing study. FDS scores decreased from 42.0 ± 19.1 to 32.3 ± 17.8 in the SM group and from 44.8 ± 17.4 to 32.9 ± 18.8 in the SI group by per-protocol (PP) analysis, and those decreased from 41.2 ± 20.9 to 34.5 ± 20.3 in the SM group and from 44.3 ± 19.1 to 35.7 ± 20.5 in the SI group by intention-to-treat (ITT) analysis, after electrical stimulation (p < 0.001 for each). SFSs increased from 3.3 ± 1.8 to 4.2 ± 1.6 in the SM group and from 2.8 ± 1.8 to 4.0 ± 1.8 in the SI group by PP analysis, and those increased from 3.3 ± 1.6 to 3.9 ± 1.6 in the SM group and from 2.8 ± 1.9 to 3.6 ± 2.0 in the SI group by ITT analysis, after electrical stimulation (p < 0.001, respectively). However, changes in FDS scores, SFSs, penetration, and aspiration were comparable between the SM and the SI groups. The results suggest that both SM and SI therapies induced similar improvements in swallowing function in brain-injured patients.

Effect of chronic obstructive pulmonary disease on swallowing function in stroke patients.

ObjectiveTo investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group).MethodsThe subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared.ResultsThirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67±2.15) compared to the control group (2.89±1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance.ConclusionThis study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.

Effect of Repetitive Transcranial Magnetic Stimulation According to the Stimulation Site in Stroke Patients With Dysphagia.

ObjectiveTo investigate the effect of repetitive transcranial magnetic stimulation (rTMS) according to the stimulation site in subacute stroke patients with dysphagia.MethodsThis study was designed as a matched comparative study. Twenty-four patients who had dysphagia after ischemic stroke were recruited, and they were divided into two groups after matching for age and stroke lesion. The patients in group A received rTMS over the brain cortex where motor evoked potential (MEP) was obtained from the suprahyoid muscle. Group B received rTMS over the brain cortex where MEP was obtained from the abductor pollicis brevis muscle. rTMS was performed at 110% of MEP threshold, 10 Hz frequency for 10 seconds, and then repeated every minute for 10 minutes. Dysphagia status was measured by the Functional Dysphagia Scale (FDS), the Penetration-Aspiration Scale (PAS), and the Dysphagia Outcome and Severity Scale (DOSS) using the results of a videofluoroscopic swallowing study. These evaluations were measured before, immediately, and 4 weeks after rTMS.ResultsGroup A showed significant improvement compared to group B in the DOSS score immediately and 4 weeks after rTMS. There were no significant differences in the changes of FDS and PAS scores between groups A and B immediately and 4 weeks after rTMS.ConclusionrTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.

Effects of transcranial direct current stimulation (tDCS) on post-stroke dysphagia

Transcranial direct current stimulation (tDCS) combined with swallowing training might improve swallowing function in patients with post-stroke dysphagia. We investigate the effects of transcranial direct current stimulation (tDCS) combined with swallowing training on post-stroke dysphagia. Sixteen patients with post-stroke dysphagia, diagnosed using video fluoroscopic swallowing (VFSS), were randomly assigned into two groups: (1) anodal tDCS group (1 mA for 20 min), or (2) sham group (1 mA for 30 s). Patients received anodal tDCS or sham over the pharyngeal motor cortex of the affected hemisphere during 30 min of conventional swallowing training for 10 days. Functional dysphagia scale (FDS) scores based on VFSS were measured at baseline and immediately and 3 months after the intervention. The effect of tDCS on dysphagia was analyzed using a generalized linear model (GLM) with repeated measures. After the intervention, FDS scores improved in both groups without significant differences. However, 3 months after the intervention, anodal tDCS elicited greater improvement in terms of FDS compared to the sham group (β = -7.79, p = 0.041) after controlling for age, National Institutes of Health Stroke Scale (NIHSS) score, lesion size, baseline FDS score, and time from stroke onset. Anodal tDCS applied over the affected pharyngeal motor cortex can enhance the outcome of swallowing training in post-stroke dysphagia. Our results suggest that non-invasive cortical stimulation has a potential role as an adjuvant strategy during swallowing training in patients with post-stroke dysphagia.

Effect of Repetitive Transcranial Magnetic Stimulation on Patients with Brain Injury and Dysphagia

ObjectiveTo investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of the swallowing function in patients with a brain injury.MethodPatients with a brain injury and dysphagia were enrolled. Patients were randomly assigned to sham, and low and high frequency stimulation groups. We performed rTMS at 100% of motor evoked potential (MEP) threshold and a 5 Hz frequency for 10 seconds and then repeated this every minute in the high frequency group. In the low frequency group, magnetic stimulation was conducted at 100% of MEP threshold and a 1 Hz frequency. The sham group was treated using the same parameters as the high frequency group, but the coil was rotated 90° to create a stimulus noise. The treatment period was 2 weeks (5 days per week, 20 minutes per session). We evaluated the Functional Dysphagia Scale (FDS) and the Penetration Aspiration Scale (PAS) with a videofluoroscopic swallowing study before and after rTMS.ResultsThirty patients were enrolled, and mean patient age was 68.2 years. FDS and PAS scores improved significantly in the low frequency group after rTMS, and American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale scores improved in the sham and low frequency groups. FDS and PAS scores improved significantly in the low frequency group compared to those in the other groups.ConclusionWe demonstrated that low frequency rTMS facilitated the recovery of swallowing function in patients with a brain injury, suggesting that rTMS is a useful modality to recover swallowing function.

The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer

The purpose of this study was to evaluate the effect of neuromuscular electrical stimulation (NMES) in patients suffering from dysphagia following treatment for head and neck cancer. In a prospective, double blinded, randomized case control study between January 2006 and December 2007, 14 patients were randomized to 30min of NMES and 30min of traditional swallowing training for 5 days per week for 2 weeks (experimental group), and 12 patients were randomized to sham stimulation plus traditional swallowing training (control group). Effects were assessed using the clinical dysphagia scale (CDS), the functional dysphagia scale (FDS), the American speech-language-hearing association national outcome measurement system (ASHA NOMS) and the M.D. Anderson dysphagia inventory (MADI). Pretreatment evaluation showed no significant differences between the two groups for all parameters. Average changes of FDS score were 11.4+/-8.1 for the experimental group and 3.3+/-14.0 for the control group (P=0.039). CDS, ASHA NOMS and MADI showed some difference with treatment, but the changes were not significant (P>0.05). NMES combined with traditional swallowing training is superior to traditional swallowing training alone in patients suffering from dysphagia following treatment for head and neck cancer.