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Krishnamurthy R, Cloud C, Westemeyer R, Wang Y, Schultz DH, Dietsch AM. White Matter Microstructural Correlates of Swallowing Biomechanics: An Exploratory Pilot Study in Healthy Young Adults. Dysphagia 2025:10.1007/s00455-025-10841-3. [PMID: 40423782 DOI: 10.1007/s00455-025-10841-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 04/30/2025] [Indexed: 05/28/2025]
Abstract
White matter (WM) enables complex brain connectivity by linking several cortical and subcortical regions. Most studies investigating the association between WM tracts and swallowing function have predominantly used a disease (lesion) based approach, and there is currently a paucity of research investigating the associations between swallowing physiology and WM microstructure in healthy individuals. Moreover, studies in healthy individuals are essential to understanding typical WM architecture and identifying any deviations caused by diseases or adaptations resulting from specific interventions or training regimes. The current study addresses this critical gap by investigating the association between quantitative metrics of WM microstructure and kinematic and temporal measures of swallowing biomechanics in healthy young adults. Diffusion-weighted magnetic resonance imaging (DW-MRI) was obtained from 17 right-handed healthy adults (males = 9; females = 8) aged 20 to 35 (mean age = 27.11 years). DW-MRI was pre-processed and analyzed using a custom-developed analysis pipeline to generate diffusion tensor image (DTI) derived scalar measures. Furthermore, videofluoroscopic data were collected from these participants and quantified using computational analysis of swallowing mechanics (CASM) and traditional pixel-based temporal and kinematic measures. We performed partial correlations to explore the association between swallowing biomechanics and WM diffusion metrics, with participants' age and sex as covariates. Our study revealed that the corpus callosum, cerebellar peduncle, thalamic radiation, corticospinal tract, cingulum, stratum, corona radiata, fornix, internal capsule, external capsule, and the superior frontal-occipital fasciculus showed significant bidirectional associations with the kinematic and temporal measures of swallowing biomechanics investigated in the current study. These findings are interpreted in relation to lesion studies and well-established functions of WM tracts. Future directions and limitations of our study are also discussed.
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Affiliation(s)
- Rahul Krishnamurthy
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, USA.
| | - Caitlin Cloud
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Ross Westemeyer
- Department of Communication Sciences and Disorders, University of Northern Iowa, Cedar Falls, IA, USA
| | - Yingying Wang
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Douglas H Schultz
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
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Wilmskoetter J, Bonilha H, Wolf BJ, Tracy E, Chang A, Martin-Harris B, Anne Holmstedt C, Bonilha L. Cerebral small vessel disease is an independent determinant of dysphagia after acute stroke. Neuroimage Clin 2024; 44:103710. [PMID: 39577333 PMCID: PMC11616564 DOI: 10.1016/j.nicl.2024.103710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 11/06/2024] [Accepted: 11/18/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND The high incidence of dysphagia after acute stroke is likely the result of cumulative effects of the stroke and pre-stroke brain health. While cerebral small vessel disease (cSVD) is recognized as a marker of compromised brain health, it's unclear which neuroanatomical pathologies of cSVD impact post-stroke dysphagia. We assessed the relation between cSVD pathologies, i.e., brain atrophy, white matter hyperintensities (WMH), perivascular spaces, as markers for brain integrity at the time of the stroke, and acute post-stroke dysphagia measured with the Modified Barium Swallow Study (MBSS). METHODS We conducted a retrospective, observational study of 40 individuals with an acute first-ever ischemic stroke. We segmented T1-weighted images into gray matter, white matter, and cerebrospinal fluid (CSF) to derive brain atrophy estimates. We scored the presence and severity of periventricular and deep WMH using the Fazekas scale and counted perivascular spaces in the basal ganglia following standard guidelines. Swallow impairments were determined with the Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale, and timing measures (oral (OTT), and pharyngeal transit times (PTT)). We performed regression to assess the relation between cSVD pathologies and swallowing while controlling for the stroke overlap with the right and left corticobulbar tracts, stroke volume, and the number of days between the MRI and MBSS. RESULTS Worse brain atrophy and more severe periventricular WMH were related to more severe MBSImP pharyngeal total scores, and worse deep WMH were related to aspiration events. More severe perivascular spaces in the basal ganglia were related to longer OTT and PTT, with a high explanatory value (27.5% and 25.1%, respectively), even when controlling for chronological age. CONCLUSIONS Our results suggest that several aspects of pre-stroke brain health impact dysphagia severity after acute stroke independent of the stroke site and size. These findings contribute to our understanding of mechanisms underlying the variability of post-stroke dysphagia and emphasize the importance of brain structural integrity before the stroke. Future larger studies are warranted.
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Affiliation(s)
| | | | | | - Emma Tracy
- Medical University of South Carolina, SC, USA
| | - Allen Chang
- Medical University of South Carolina, SC, USA
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Huang L, Wang Y, Sun J, Zhu L, Liu J, Wu Y, Shan C, Yan J, Wan P. Incidence and Risk Factors for Dysphagia Following Cerebellar Stroke: a Retrospective Cohort Study. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1293-1303. [PMID: 37204664 PMCID: PMC11269328 DOI: 10.1007/s12311-023-01564-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
The cerebellum is known to play a supportive role in swallowing-related functions; however, wide discrepancies about the incidence rate of swallowing disorders following cerebellar strokes exist within the literature. This study aimed to investigate the incidence rate of dysphagia and the factors which may affect the presence of dysphagia and clinical recovery in individuals diagnosed with cerebellar stroke. A retrospective chart audit of 1651 post-stroke patients (1049 males and 602 females) admitted with a cerebellar stroke to a comprehensive tertiary hospital in China was conducted. Data on demographics, medical, along with swallowing function assessment were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t-tests and Pearson's chi-square test. Univariate logistic regression analysis was performed to establish factors associated with the presence of dysphagia. A total of 11.45% of participants were identified with dysphagia during inpatient admission. Individuals with mixed types of stroke, multiple lesions in the cerebellum, and ages older than 85 years old were more likely to develop dysphagia. Moreover, the prognosis of dysphagia following a cerebellar stroke was associated with lesions in different parts of the cerebellum. The cumulative recovery rates from the best to worse were the right hemisphere group, the cerebellum vermis or peduncle group, and both the hemisphere group and the left hemisphere group, respectively.
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Affiliation(s)
- Li Huang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yunlu Wang
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Jikang Sun
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Lequn Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Jimin Liu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Yuwei Wu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Chunlei Shan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Juntao Yan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Ping Wan
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
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Wei KC, Wang TG, Hsiao MY. The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review. Dysphagia 2024; 39:177-197. [PMID: 37603047 DOI: 10.1007/s00455-023-10613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
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Labeit B, Michou E, Hamdy S, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, Dziewas R. The assessment of dysphagia after stroke: state of the art and future directions. Lancet Neurol 2023; 22:858-870. [PMID: 37596008 DOI: 10.1016/s1474-4422(23)00153-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 08/20/2023]
Abstract
Dysphagia is a major complication following an acute stroke that affects the majority of patients. Clinically, dysphagia after stroke is associated with increased risk of aspiration pneumonia, malnutrition, mortality, and other adverse functional outcomes. Pathophysiologically, dysphagia after stroke is caused by disruption of an extensive cortical and subcortical swallowing network. The screening of patients for dysphagia after stroke should be provided as soon as possible, starting with simple water-swallowing tests at the bedside or more elaborate multi-consistency protocols. Subsequently, a more detailed examination, ideally with instrumental diagnostics such as flexible endoscopic evaluation of swallowing or video fluoroscopy is indicated in some patients. Emerging diagnostic procedures, technical innovations in assessment tools, and digitalisation will improve diagnostic accuracy in the future. Advances in the diagnosis of dysphagia after stroke will enable management based on individual patterns of dysfunction and predisposing risk factors for complications. Progess in dysphagia rehabilitation are essential to reduce mortality and improve patients' quality of life after a stroke.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany; Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany.
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Achaia, Greece; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany; Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck-Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
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Ikenouchi H, Nozue K, Yamaguchi S, Miyamoto T, Yamamoto N, Endo K. Geriatric nutrition risk index predicts prolonged post-stroke dysphagia in acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107207. [PMID: 37295174 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Post-stroke dysphagia (PSD) is a common complication after stroke. Malnutrition inhibits stroke recovery and is associated with stroke mortality. However, no studies have investigated the effects of nutritional state at admission on prolonged PSD. METHODS We retrospectively analyzed ischemic stroke patients in our institute from January 2018 to December 2020. Swallowing function was assessed using the Food Oral Intake Scale; prolonged PSD was defined as levels 1-3 at 14 days after admission. The Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional risks, which were classified as follows: >98, no nutritional risk; 92-98, mild nutritional risk; 82-92, moderate nutritional risk; and <82, severe nutritional risk. The association between GNRI and prolonged PSD was assessed. RESULTS Of 580 patients (median age, 81 years; male, 53%), prolonged PSD was detected in 117 patients. Patients with severe dysphagia had older age, higher pre-stroke modified Rankin Scale score, lower GNRI, and higher National Institutes of Health Stroke Scale score. Logistic regression analysis revealed that lower GNRI was independently associated with prolonged PSD (continuous value; adjusted odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05). In addition, when "severe" and "moderate" nutritional risk was analyzed as a single class, moderate or severe nutritional risk (GNRI < 92) was independently associated with prolonged PSD (adjusted OR 2.50, 95% CI 1.29-4.87), compared with no nutritional risk patients (GNRI > 98). CONCLUSIONS In acute ischemic stroke, lower GNRI at admission was independently associated with prolonged PSD, suggesting that GNRI at admission might identify patients at risk of prolonged PSD.
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Affiliation(s)
- Hajime Ikenouchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan.
| | - Kei Nozue
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Satoru Yamaguchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Tatsuo Miyamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Naoki Yamamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
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Qin Y, Tang Y, Liu X, Qiu S. Neural basis of dysphagia in stroke: A systematic review and meta-analysis. Front Hum Neurosci 2023; 17:1077234. [PMID: 36742358 PMCID: PMC9896523 DOI: 10.3389/fnhum.2023.1077234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives Dysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD) can help in early screening and clinical intervention. Studies on PSD have reported numerous structural lesions and functional abnormalities in brain regions, and a systematic review is lacking. We aimed to integrate several neuroimaging studies to summarize the empirical evidence of neurological changes leading to PSD. Methods We conducted a systematic review of studies that used structural neuroimaging and functional neuroimaging approaches to explore structural and functional brain regions associated with swallowing after stroke, with additional evidence using a live activation likelihood estimation (ALE) approach. Results A total of 35 studies were included, including 20 studies with structural neuroimaging analysis, 14 studies with functional neuroimaging analysis and one study reporting results for both. The overall results suggest that structural lesions and functional abnormalities in the sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections in individuals with stroke may contribute to dysphagia, and the ALE analysis provides additional evidence for structural lesions in the right lentiform nucleus and right thalamus and functional abnormalities in the left thalamus. Conclusion Our findings suggest that PSD is associated with neurological changes in brain regions such as sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections. Adequate understanding of the mechanisms of neural changes in the post-stroke swallowing network may assist in clinical diagnosis and provide ideas for the development of new interventions in clinical practice.
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Affiliation(s)
- Yin Qin
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,*Correspondence: Yin Qin,
| | - Yuting Tang
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoying Liu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
| | - Shuting Qiu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Wang L, Yao J, Guan B, Xu J, Yu H, Li H. The efficacy and safety of catheter balloon dilatation in the treatment of dysphagia after stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31460. [PMID: 36343051 PMCID: PMC9646636 DOI: 10.1097/md.0000000000031460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Dysphagia is a serious complication after stroke, which has a significant influence on the health as well as life quality of global people. Patients with dysphagia tend to be a higher risk rate of an aspiration than general person. Catheter balloon dilatation is an additional therapy for treating dysphagia in recent years, which can improve the symptom of achalasia of cricopharyngeal muscle. This research will be used for confirming the efficacy and safety of the catheter balloon dilatation for resolving dysphagia. METHODS We intend to search literature related to the research in different databases, for instance, China National Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library, and Embase up to January 2022. Literature selection, data collection, as well as assessment of bias risk, will be carried out by 2 independent researchers. Data analysis will be conducted by using Stata and review manager 5.4. RESULTS The results will be submitted to a peer-reviewed journal. CONCLUSION The research will verify whether or not catheter balloon dilatation can improve dysphagia by submitting high-quality data syntheses. REGISTRATION NUMBER CRD42022358433.
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Affiliation(s)
- Lin Wang
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
| | - Jian Yao
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
| | - Bugao Guan
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
| | - Jin Xu
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
| | - Haitao Yu
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
| | - Hongbo Li
- Rehabilitation Medicine Department, Jinhu County People’s Hospital, Huai’an City, Jiangsu Province, China
- *Correspondence: Hongbo Li, Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province 211600, China (e-mail: )
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Chang MC, Seo Y, Kwak S. Deterioration of the Corticobulbar Tract in Older Dysphagic Patients Without Neurologic Diseases. Am J Phys Med Rehabil 2022; 101:353-357. [PMID: 35302528 DOI: 10.1097/phm.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Less is known how dysphagia affects older patients without neurologic diseases and whether the symptoms of dysphagia have any association with impaired central control of swallowing. This study investigated the state of the corticobulbar tract, the surrogate marker for the central control of swallowing, in older dysphagic patients without any neurologic diseases, using diffusion tensor tractography. DESIGN This retrospective observational study was conducted at a tertiary university hospital including 10 patients 60 yrs or older with oropharyngeal dysphagia without neurological disease and 11 age- and sex-matched control participants. The corticobulbar tract was reconstructed, and the fractional anisotropy and tract volume were measured using diffusion tensor tractography. RESULTS The corticobulbar tracts of the dysphagia group were narrowed and not reconstructed by their configurations and had lower fractional anisotropy and tract volume values when compared with those of control group. Significant asymmetry between the left and the right corticobulbar tract hemispheres was found in the dysphagia group, whereas no asymmetry was found in the control group. CONCLUSIONS A deteriorated corticobulbar tract could be associated with the development of dysphagia in older adults without neurological diseases. Our findings might help establish more appropriate treatment strategies, such as targeted neuromodulation therapies in the future.
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Affiliation(s)
- Min Cheol Chang
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
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Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
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Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tractography study. Dysphagia 2020; 36:680-688. [PMID: 32865624 DOI: 10.1007/s00455-020-10182-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
We investigated the capacity for dysphagia prognosis prediction using diffusion tensor tractography (DTT) to assess the state of the corticobulbar tract (CBT) during the initial period following lateral medullary infarction (LMI). Twenty patients with LMI and 20 control subjects were recruited for this study. The patients were classified into two subgroups: subgroup A (16 patients with nasogastric tube required for six months or less after LMI onset) and subgroup B (4 patients with nasogastric tube required for more than six months after onset). DTT was used to reconstruct the CBTs of each patient and control subject, and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained. In the affected hemisphere, the FA value of the CBT was significantly lower in subgroup B than in subgroup A and the control group (p < 0.05), with no significant difference between subgroup A and the control group. In the affected and unaffected hemispheres, the TV values of CBT in subgroups A and B were lower than those of the control group (p < 0.05), with no significant difference between subgroups A and B. In addition, among the four patients of subgroup B, reconstruction of the CBT was not possible in three patients, and the remaining patients exhibited on old lesion in the corona radiate involving descending pathway of the CBT in the affected hemisphere. We found that the injury severity of the CBT in the affected hemisphere appeared to be related to a poor dysphagia prognosis following LMI. Our results suggest that evaluation of the CBT state during the early post-LMI could be useful for dysphagia prognosis prediction.
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Im S, Han YJ, Kim SH, Yoon MJ, Oh J, Kim Y. Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke. Eur J Neurol 2020; 27:2158-2167. [PMID: 32524719 DOI: 10.1111/ene.14387] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke. METHODS Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity. RESULTS The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976). CONCLUSIONS The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.
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Affiliation(s)
- S Im
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - Y J Han
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - M-J Yoon
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - J Oh
- Rehabilitation Medicine, Independent Scholar, Seoul, Korea
| | - Y Kim
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home. Int J Rehabil Res 2020; 43:55-61. [DOI: 10.1097/mrr.0000000000000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jang SH, Kwak SY, Chang CH, Jung YJ, Kim J, Kim SH, Kim JY. Prognostic Prediction of Dysphagia by Analyzing the Corticobulbar Tract in the Early Stage of Intracerebral Hemorrhage. Dysphagia 2020; 35:985-992. [PMID: 32040613 DOI: 10.1007/s00455-020-10093-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
We investigated the predictive value of the corticobulbar tract (CBT) for dysphagia using diffusion tensor tractography in the early stage of intracerebral hemorrhage (ICH) for dysphagia. Forty-two patients with spontaneous ICH ± intraventricular hemorrhage (IVH) and 22 control subjects were recruited. The patients were classified into three groups: group A-could remove nasogastric tube (NGT) in the acute stage of ICH, group B-could remove NGT within 6 months after onset, and group C-could not remove NGT until 6 months after onset. The CBT were reconstructed, and fractional anisotropy (FA) and tract volume (TV) values were determined. The FA of the CBT in the affected hemisphere in group A was lower than in the control group (p < 0.05). The FA and TV of the CBT in the affected hemisphere in group B were lower than those in the control group (p < 0.05). In group C, the FA and TV in the affected hemisphere and unaffected hemispheres were lower than in the control group (p < 0.05). The TV of the CBT in the affected hemisphere in group B showed a moderate negative correlation with the length of time until NGT removal (r = 0.430, p < 0.05). We found that patients with CBT injuries in both hemispheres were not able to remove the NGT until 6 months after onset, whereas patients who were injured only in the affected hemisphere were able to remove NGT within 6 months of onset. The severity of injury to the CBT in the affected hemisphere appeared to be related to the length of time until NGT removal.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - So Young Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - JongHoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Jun Young Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea.
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