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Physiol Behav. 2018 Oct 1;194:144-152. doi: 10.1016/j.physbeh.2018.05.010. Epub 2018 May 11.

Differences in swallow physiology in patients with left and right hemispheric strokes.

Author information

1
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA; Department of Neurology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC 29425, USA. Electronic address: wilmskoe@musc.edu.
2
Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, IL, USA; Otolaryngology Head and Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, IL, USA. Electronic address: bonnie.martinharris@northwestern.edu.
3
Department of Cellular Biology and Anatomy, Augusta University, 1120 15th Street, Augusta, GA 30912, USA. Electronic address: wpearson@augusta.edu.
4
Department of Neurology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC 29425, USA. Electronic address: bonilha@musc.edu.
5
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon St, MSC 835, Charleston, SC 29425, USA. Electronic address: elmj@musc.edu.
6
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA. Electronic address: cucciare@musc.edu.
7
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA; Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, USA. Electronic address: bonilhah@musc.edu.

Abstract

BACKGROUND:

We sought to determine the impact of lesion lateralization and lesion volume on swallow impairment on group-level by comparing patients with left and right hemisphere strokes and on patient-level by analyzing patients individually.

METHODS:

We performed a retrospective, observational, cross-sectional study of 46 patients with unilateral (22 left, 24 right), acute, first-ever, ischemic strokes who received a diffusion weighted MRI (DW-MRI) and modified barium swallow study (MBSS) during their acute hospital stay. We determined lesion side on the DW-MRI and measured swallow physiology using the Modified Barium Swallow Impairment Profile (MBSImP™©), Penetration-Aspiration Scale (PAS), swallow timing, distance, area, and speed measures. We performed Pearson's Chi-Square and Wilcoxon Rank-Sum tests to compare patients with left and right hemisphere strokes, and Pearson or Spearman correlation, simple logistic regression, linear, and logistic multivariable regression modeling to assess the relationship between variables.

RESULTS:

At the group-level, there were no differences in MBSImP oral swallow impairment scores between patients with left and right hemisphere stroke. In adjusted analyses, patients with right hemisphere strokes showed significantly worse MBSImP pharyngeal total scores (p = 0.02), worse MBSImP component specific scores for laryngeal vestibular closure (Bonferroni adjusted alpha p ≤ 0.0029), and worse PAS scores (p = 0.03). Patients with right hemisphere strokes showed worse timing, distance, area, and speed measures. Lesion volume was significantly associated with MBSImP pharyngeal residue (p = 0.03) and pharyngeal total scores (p = 0.04). At the patient-level, 24% of patients (4 left, 7 right) showed opposite patterns of MBSImP oral and pharyngeal swallow impairment than seen at group-level.

CONCLUSION:

Our study showed differences in swallow physiology between patients with right and left unilateral strokes with patients with right hemisphere strokes showing worse pharyngeal impairment. Lesion lateralization seems to be a valuable marker for the severity of swallowing impairment at the group-level but less informative at the patient-level.

KEYWORDS:

Cerebral hemispheres; Deglutition; Deglutition disorders; Stroke

PMID:
29758228
PMCID:
PMC6070395
[Available on 2019-10-01]
DOI:
10.1016/j.physbeh.2018.05.010
[Indexed for MEDLINE]

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