Objective To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients.
Methods This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient’s AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed.
Results AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group.
Conclusion Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.
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Objective To identify the relationship between maximum phonation time (MPT) and swallowing function, as well
as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism
manifesting dysphagia.
Methods Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing
study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated.
The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety
Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and
MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson
disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and
the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test.
Results Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group
compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time,
pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the
impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the
NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself.
Conclusion The correlation between MPT and several swallowing-related elements was identified, indicating an
interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for
dysphagia in patients with Parkinsonism.
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