Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients

Abstract

ObjectiveTo compare the swallowing characteristics of dysphagic patients with traumatic brain injury (TBI) with those of dysphagic stroke patients.MethodsForty-one patients with TBI were selected from medical records (between December 2004 to March 2013) and matched to patients with stroke (n=41) based on age, sex, and disease duration. Patients' swallowing characteristics were analyzed retrospectively using a videofluoroscopic swallowing study (VFSS) and compared between both groups. Following thorough review of medical records, patients who had a history of diseases that could affect swallowing function at the time of the study were excluded. Dysphagia characteristics and severity were evaluated using the American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale, clinical dysphagia scale, and the videofluoroscopic dysphagia scale.ResultsThere was a significant difference in radiological lesion location (p=0.024) between the two groups. The most common VFSS finding was aspiration or penetration, followed by decreased laryngeal elevation and reduced epiglottis inversion. Swallowing function, VFSS findings, or quantified dysphagia severity showed no significant differences between the groups. In a subgroup analysis of TBI patients, the incidence of tube feeding was higher in patients with surgical intervention than in those without (p=0.011).ConclusionThe swallowing characteristics of dysphagic patients after TBI were comparable to those of dysphagic stroke patients. Common VFSS findings comprised aspiration or penetration, decreased laryngeal elevation, and reduced epiglottis inversion. Patients who underwent surgical intervention after TBI were at high risk of tube feeding requirement.

Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults

“…Starmer et al (2015) reported that patients with post-radiated submental muscles who penetrated and aspirated also had decreased dLVC (Starmer et al, 2015). These, and many other studies that link disordered LVC to aspiration, highlight the complexity of LVC mechanics and its pathophysiology (Lee et al, 2016; Power et al, 2009; Power et al, 2007). To our knowledge, the vLVC swallowing maneuver is the only treatment option that requires individuals to focus on modifying LVC gestures alone during a swallow.…”

Caregivers’ Perspectives on the Slight Recovery of Oral Intake of Home‐Dwelling Patients Living With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Study Using Focus Group Interviews

“…What does an eating and swallowing rehabilitation visit mean for the provision of long-term care for your family member at home? study participants were: (1) the cause of dysphagia was stroke or TBI (these were unified into a single disease within 1 focus group interview); (2) >1 year had passed from the initiation of EN via a PEG tube for the patient; (3) the score of the modified Rankin Scale (mRS), a physical assessment tool of disability due to stroke, was 4 or 5 20 ; (4) the main nutrition supply was via a feeding tube; (5) the patient retained the ability to communicate, including via nonverbal communication; (6) the patient lived in a home with a family caregiver; and (7) the patient had received periodic swallowing rehabilitation visits for >1 year. Swallowing ability was estimated by the Functional Oral Intake Scale (FOIS), with a low score indicating severe dysphagia (range: 1-7).…”

“…The reported prevalence of dysphagia at 6 months after onset is 50% in stroke survivors . The prevalence of dysphagia with TBI in the chronic phase is unknown; however, the characteristics and severity of dysphagia between stroke patients and TBI patients are not significantly different …”

“…5 The prevalence of dysphagia with TBI in the chronic phase is unknown; however, the characteristics and severity of dysphagia between stroke patients and TBI patients are not significantly different. 6 A percutaneous endoscopic gastrostomy (PEG) tube for enteral nutrition (EN) is important for patients who are unable to eat orally. 7 Thus, home enteral nutrition (HEN), including feeding via a PEG tube, is increasing worldwide for patients with chronic dysphagia.…”

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

“…3 Dysphagia also may result from traumatic or nontraumatic brain injury, depending on the area and extent of injury. 6 Spinal cord injury can cause dysphagia as well. [7][8][9] Neurodegenerative diseases and neuromuscular diseases, including but not limited to Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophies, poliomyelitis, myasthenia gravis, and dementias, are other causes of dysphagia.…”