Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy

Abstract

Background: Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia.Methods: We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment.Results: FOIS (p = 0.003 in hemispheric group and p = 0.039 in brainstem group) and FDS (p = 0.006 in hemispheric group and p = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI.Conclusion: Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.

Different Patterns of Functional Connectivity Alterations Within the Default-Mode Network and Sensorimotor Network in Basal Ganglia and Pontine Stroke

“…The SMN includes somatosensory and motor regions and extends to the supplementary motor areas [33]. Both pontine and hemispheric lesions after stroke can lead to motor or sensory deficits [34]. In the present study, although both basal ganglia stroke and patients with pontine stroke exhibited involvement of the motor pathway, FC was weakened in different sensorimotor regions.…”

“…The SMN includes somatosensory and motor regions and extends to the supplementary motor areas [33]. Both pontine and hemispheric lesions after stroke can lead to motor or sensory deficits [34].…”

Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury

“…12 13 The clinical presentation of swallowing impairment is dependent on the origin and type of ABI, and may be caused by sensory and/or motor deficits. 14 Swallowing is a multifaceted process requiring interaction and coordination of conscious and autonomous responses with precise coordination of multiple muscle groups in the oral cavity, pharynx and larynx. 15 Swallowing is coordinated mainly by a swallowing centre, an interneuronal network centred in the brain stem, receiving peripheral sensory inputs from the pharynx and larynx and central inputs from the cortex.…”

Protocol for a scoping review study to identify and map treatments for dysphagia following moderate to severe acquired brain injury

“…Neurogenic dysphagia, or swallowing disorder, can occur in one or more phases of the swallowing process: pre-oral, oral, pharyngeal and/or oesophageal 12. The occurrence of swallowing impairment is dependent on the origin and type of ABI, and may be caused by sensory and/or motor deficits 13…”