Citation Information :
Ghosal A, Kumar De S, Sinharay S, Ray BK, Pramanik R. Improvement Pattern of VFSS due to Swallowing Maneuvers in Patients of Dysphagia with Posterior Circulation Stroke. Indian J Phy Med Rehab 2020; 31 (2):24-30.
Background: Post-stroke dysphagia is a leading cause of morbidity and prolonged hospitalization in stroke patients. The videofluoroscopic swallowing study (VFSS) is one of the gold standard techniques, designed to define the anatomy and physiology of a patient\'s oropharyngeal swallow and examine the effectiveness of selected rehabilitation strategies designed to eliminate aspiration or excess oral or pharyngeal residue (the symptoms of patient\'s dysphagia).
Objective: To quantify the improvement of patients’ subjective and objective symptoms.
Materials and methods: Institutional ethics committee clearance was taken. Fifteen patients were selected who satisfy our inclusion criteria. A prospective interventional study was done in the Department of PMR, IPGME&R, Kolkata over 12 months. Videofluoroscopic swallowing study was done on all these patients at baseline and at 3 months interval and swallowing technique of head rotation to the paretic side applied at baseline and Mendelsohn maneuvers were applied for 3 months duration. Changes in VAS of swallowing (VASs) and videofluoroscopic dysphagia scale (VDS) were noted.
Inclusion criteria: Clinical dysphagia in a patient with confirmed posterior circulation stroke, after 2 weeks of stroke.
Exclusion criteria: Anterior circulation stroke, Other pertinent neurological diseases, any structural abnormalities in head-neck region, medically unstable patient.
Results: Statistically significant improvements of both VASs and VDS were seen in all the patients in follow-up visits with the application of selected swallowing techniques and maneuvers.
Conclusion: This study concludes that:
• Simple swallowing techniques and maneuvers can improve the symptoms of dysphagia in patients with posterior circulation stroke.• Videofluoroscopy is helpful to diagnose and objectively quantify the improvement of dysphagia symptoms with different swallowing techniques and maneuvers.
Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36(12):2756–2763. DOI: 10.1161/01.STR.0000190056.76543.eb.
Smithard DG, O'Neill PA, England RE, et al. The natural history of dysphagia following a stroke. Dysphagia 1997;12(4):188–193. DOI: 10.1007/PL00009535.
Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999;30(4):744–748. DOI: 10.1161/01.STR.30.4.744.
Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006;82(968):383–391. DOI: 10.1136/pgmj.2005.043281.
Norrving B. Medullary infarcts and hemorrhages. In: Bogousslavsky J, Caplan L, ed. Stroke Syndromes. 2nd ed., Cambridge: Cambridge University Press; 2001. 534–539.
Kim JS, Lee JH, Suh DC, et al. Spectrum of lateral medullary syndrome: correlation between clinical findings and magnetic resonance imaging in 33 subjects. Stroke 1994;25(7):1405–1410. DOI: 10.1161/01.STR.25.7.1405.
Kim JS. Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain 2003;126(8):1864–1872. DOI: 10.1093/brain/awg169.
Kameda W, Kawanami T, Kurita K, et al. Lateral and medial medullary infarction: a comparative analysis of 214 patients. Stroke 2004;35(3):694–699. DOI: 10.1161/01.STR.0000117570.41153.35.
Kwon M, Lee JH, Kim JS. Dysphagia in unilateral medullary infarction lateral vs medial lesions. Neurology 2005;65(5):714–718. DOI: 10.1212/01.wnl.0000174441.39903.d8.
Kim JS, Kim HG, Chung CS. Medial medullary syndrome: reports of 18 new patients and a review of the literature. Stroke 1995;26(9):1548–1552. DOI: 10.1161/01.STR.26.9.1548.
Arnold M, Liesirova K, Broeg-Morvay A, et al. Dysphagia in acute atroke: incidence, burden and impact on clinical outcome. PLoS ONE 2016;11(2):e0148424. DOI: 10.1371/journal.pone.0148424.
Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovascu Dis 2009;18(5):329–335. DOI: https://doi.org/https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009.
Terre R, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil 2006;18(3):200–205. DOI: 10.1111/j.1365-2982.2005.00729.x.
Smithard DG, O'Neill PA, Park C, et al. Complications and outcome after acute stroke. does dysphagia matter? Stroke 1996;27(7):1200–1204. DOI: 10.1161/01.STR.27.7.1200.
Finestone HM, Greene-Finestone LS, Wilson ES, et al. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch Phys Med Rehabil 1995;76(4):310–316. DOI: 10.1016/S0003-9993(95)80655-5.
Ekberg O, Hamdy S, Woisard V, et al. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 2002;17(2):139–146. DOI: 10.1007/s00455-001-0113-5.
Broussard DL, Altschuler SM. Brainstem viscerotopic organization of afferents and efferents involved in the control of swallowing. Am J Med 2000;108(Suppl 4a):79S–86S. DOI: 10.1016/S0002-9343(99)00343-5.
Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev 2001;81(2):929–969. DOI: 10.1152/physrev.2001.81.2.929.
Jean A. Brainstem organization of the swallowing network. Brain Behav Evol 1984;25(2-3):109–116. DOI: 10.1159/000118856.
Aydogdu I, Ertekin C, Tarlaci S, et al. Dysphagia in lateral medullary infarction (Wallenberg's syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity? Stroke 2001;32(9):2081–2087. DOI: 10.1161/hs0901.094278.
Kim H, Chung CS, Lee KH, et al. Aspiration subsequent to a pure medullary infarction: lesion sites, clinical variables, and outcome. Arch Neurol 2000;57(4):478–483. DOI: 10.1001/archneur.57.4.478.
Kirchner JA. Pharyngeal and esophageal dysfunction: the diagnosis. Minn Med 1967;50:921–924.
Logemann JA. Evaluation and Treatment of Swallowing Disorders. 2nd ed., Austin: Pro-Ed; 1998. p. 1.
Logemann J. Evaluation and Treatment of Swallowing Disorders. 2nd ed., Austin: Pro-Ed; 1998. p. 152.
Horner J, Brazer SR, Massey EW. Aspiration in bilateral stroke patients: a validation study. Neurology 1993;43(2):430–433. DOI: 10.1212/WNL.43.2.430.
Gonzalez-Fernandez M, Sein MT, Palmer JB. Clinical experience using the mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. Am J Speech Lang Pathol 2011;20(4):331–336. DOI: 10.1044/1058-0360(2011/10-0082).
Palmer JB, Kuhlemeier KV, Tippett DC, et al. A protocol for the videofluorographic swallowing study. Dysphagia 1993;8(3):209–214. DOI: 10.1007/BF01354540.
Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia 2008;23(4):392–405. DOI: 10.1007/s00455-008-9185-9.
Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am 2008;19(4):769–785. DOI: viii.10.1016/j.pmr.2008.06.004.
Logemann JA. Manual for the Videofluorographic Study of Swallowing, 2., Austin, TX: Pro-Ed, Inc; 1993.
Kim SB, Lee SJ, Lee KW, et al. Usefulness of early videofluoroscopic swallowing study in acute stroke patients with dysphagia. Ann Rehabilitat Med 2018;42(1):42–51. DOI: https://doi.org/10.5535/arm.2018.42.1.42.
Logemann J. Evaluation and Treatment of Swallowing Disorders. 2nd ed., Austin: Pro-Ed; 1998. p. 196.
Logemann JA, Kahrilas PJ, Kobara M, et al. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabilitat 1989;70:767–771.
Lee H, Rho H, Cheon HJ, et al. Selection of head turn side on pharyngeal dysphagia in hemiplegic stroke patients: a preliminary study. Brain Neurorehabil 2018;11(2):e19. DOI: 10.12786/bn.2018.11.e19.
Logemann JA. Evaluation and Treatment of Swallowing Disorders. 2nd ed., Austin: Pro-Ed; 1998. pp. 1–7.
Martino R, Terrault N, Ezerzer F, et al. Dysphagia in a patient with lateral medullary syndrome: insight into central control of swallowing. Gastroenterology 2001;121(2):420–426. DOI: 10.1053/gast.2001.26291.
Bartolome G, Neumann S. Swallowing therapy in patients with neirological dysfunction. Dysphagia 1993;8(2):146–149. DOI: 10.1007/BF02266995.
McCullough GH, Kamarunas E, Mann GC, et al. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil 2012;19(3):234–243. DOI: 10.1310/tsr1903-234.
Inamoto Y, Saitoh E, Ito Y, et al. The Mendelsohn maneuver and its effects on swallowing: kinematic analysis in three dimensions using dynamic area detector CT. Dysphagia 2018;33(4):419–430. DOI: https://doi.org/10.1007/s00455-017-9870-7.
Jongprasitkul H, Kitisomprayoonkul W. Effectiveness of conventional swallowing therapy in acute stroke patients with Dysphagia. Rehabil Res Pract 2020;2020:1–5. DOI: https://doi.org/10.1155/2020/2907293.
Bülow M, Speyer R, Baijens L, et al. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia 2008;23(3):302–309. DOI: https://doi.org/10.1007/s00455-007-9145-9.
Han TR, Paik NJ, Park JW, et al. The prediction of persistent Dysphagia beyond six months after stroke. Dysphagia 2008;23(1):59–64. DOI: https://doi.org/10.1007/s00455-007-9097-0.
Priya CM, Menon JR. Cricopharyngeal dysfunction in lateral medullary syndrome. J Laryngol Voice 2014;4(1):21–27. DOI: 10.4103/2230-9748.141461.
Park JW, OH JC, Lee JW, et al. The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study. Neurogastroenterol Motil 2013;25(4):324–e250. DOI: 10.1111/nmo.12063.