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This retrospective study determined whether specific neurological features were associated with initial and final swallowing outcomes in acute stroke patients. A chart review of 65 acute stroke patients suggested that certain clinical and neurocognitive behaviors were associated with swallowing outcomes. Hemispatial neglect was significantly associated with initial nonoral dietary intake, whereas aphasia was not associated with swallowing outcome. Results from the initial clinical swallowing evaluations suggested that the presence of at least four of six clinical features (cough after swallow, voice change after swallow, abnormal volitional cough, abnormal gag reflex, dysphonia, and dysarthria) were associated with poor initial and final swallowing outcomes. Whether specific lesion location, size, or a combination of clinical neurological deficits are associated with poor initial and final swallowing outcomes is unclear. Prospective studies are warranted for further investigation of these relationships. [ABSTRACT FROM AUTHOR]

This study began development of a standard method that uses the videofluoroscopic swallow study for evaluation of swallowing recovery after stroke based on a definition of dysphagia derived from three domains: bolus timing, bolus direction, and bolus clearance. Two experiments were conducted: one that defined normal versus disordered swallowing based on the range of scores in a sample of healthy adults (n = 13), and one that applied these thresholds to nine stroke patients to identify the presence of dysphagia. Results indicate that acute and protracted dysphagia may be more accurately detected by identifying abnormalities on multiple objective measures of swallowing rather than on laryngeal penetration or aspiration alone. Results indicate that our selected measures and use of healthy control subjects to establish normal thresholds may eventually contribute to the definition and differentiation of dysphagic and nondysphagic patients. Further research with a broader sample of healthy controls and stroke patients is mandatory. [ABSTRACT FROM AUTHOR]

Purpose: To continue the development of a quantified, standard method to differentiate individuals with stroke and dysphagia from individuals without dysphagia., Method: Videofluoroscopic swallowing studies (VFSS) were completed on a group of participants with acute stroke (n = 42) and healthy age-matched individuals (n = 25). Calibrated liquid volumes of 3, 5, 10, and 20 ml were administered during the VFSS. Six measures in 3 domains of bolus flow (timing, direction, and clearance) were measured. Values of these measures obtained from the control group were used to classify dysphagia within the participants., Results: The use of a single measure or single liquid volumes to classify dysphagia did not distinguish between healthy adults and individuals following stroke with and without dysphagia. Abnormality on more than 1 measure across multiple volumes appears to be a more robust method in defining dysphagia for liquids., Conclusions: Our findings indicate that the definition of dysphagia is critical in determining whether persons are classified with disordered swallowing. The definition is dependent on materials and measures evaluated. Each measure provides independent aspects to the evaluation. Determining the level of importance of each depends on the purpose of the evaluation.

Purpose: To examine the effects of verbal cuing to initiate swallowing on bolus flow measures in healthy adults., Method: Videofluoroscopic examinations were completed in 12 healthy older adults (median age=69 years) as they swallowed 5 ml of self-administered liquid barium in 2 conditions: verbally cued and noncued swallows. In the cued condition, participants held the liquid in their mouths until instructed to swallow. In the noncued condition, participants swallowed in their usual manner., Results: Verbal cue affected bolus position at onset of timing measures, thereby influencing duration. The bolus was positioned more posterior in the oral cavity at onset of oral transit for cued as compared with noncued swallows. The leading edge of the bolus at onset of the pharyngeal swallow was more superior in the pharynx for cued as compared with noncued swallows. Durations of the cued swallows were significantly shorter than for noncued swallows for all timing measures. Bolus direction scores were not significantly different between conditions., Conclusions: Findings suggest that swallowing is altered by the use of verbal cues to initiate swallowing in healthy adults. Determining whether shorter durations with implementation of verbal cues are evident in individuals with dysphagia and whether effects are beneficial or deleterious requires continued research.