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To evaluate each digital branch of the median sensory nerve and motor nerves to abductor pollicis brevis (APB) and 2nd lumbrical (2L) according to the severity of carpal tunnel syndrome (CTS).
A prospective study was performed in 67 hands of 41 patients with CTS consisting of mild, 23; moderate, 27; and severe cases, 17. Compound muscle action potentials (CMAPs) were obtained from APB and 2L, and median sensory nerve action potentials (SNAPs) were recorded from the thumb to the 4th digit. Parameters analyzed were latency of the median CMAP, latency difference of 2L and first palmar interosseous (PI), as well as latency and baseline to peak amplitude of the median SNAPs.
The onset and peak latencies of the median SNAPs revealed significant differences only in the 2nd digit, according to the severity of CTS, and abnormal rates of the latencies were significantly lower in the 2nd digit to a mild degree. The amplitude of SNAP and sensory nerve conduction velocities were more preserved in the 2nd digit in mild CTS and more affected in the 4th digit in severe CTS. CMAPs were not evoked with APB recording in 4 patients with severe CTS, but obtained in all patients with 2L recording. 2L-PI showed statistical significance according to the severity of CTS.
The branch to the 4th digit was mostly involved and the branch to the 2nd digit and 2L were less affected in the progress of CTS. The second digit recorded SNAPs and 2L recorded CMAPs would be valuable in the evaluation of severe CTS.
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To investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS).
The present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated.
In total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (κ: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement.
VDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.
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To investigate whether patterns of swallowing difficulties were associated with the location of the brain lesion, cognitive function, and severity of stroke in stroke patients.
Seventy-six patients with first-time acute stroke were included in the present investigation. Swallowing-related parameters, which were assessed videofluoroscopically, included impairment of lip closure, decreased tongue movement, amount of oral remnant, premature loss of food material, delay in oral transit time, laryngeal elevation, delay in pharyngeal triggering time, presence of penetration or aspiration, and the amount of vallecular and pyriform sinus remnants. The locations of brain lesions were classified into the frontal, parietotemporal, subcortical, medulla, pons, and cerebellum. The degree of cognitive impairment and the severity of stroke were assessed by the Mini Mental Status Examination (MMSE) and the National Institute of Health Stroke Scale (NIHSS), respectively.
An insufficient laryngeal elevation, the amount of pyriform sinus, and vallecular space remnant in addition to the incidence of aspiration were correlated with medullary infarction. Other swallowing parameters were not related to lesion topology. Lip closure dysfunction, decreased tongue movement, increased oral remnant and premature loss were associated with low MMSE scores. A delayed oral transit time were associated with NIHSS scores.
In-coordination of the lip, the tongue, and the oropharynx were associated with the degree of cognitive impairment and the stroke severity rather than with the location of the lesion, whereas incomplete laryngeal elevation and aspiration were predominant in medullary lesions.
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