Tools and Early Management of Language and Swallowing Disorders in Acute Stroke Patients

Flamand-Roze, Constance; Cauquil-Michon, Cécile; Denier, Christian

doi:10.1007/s11910-011-0241-8

Cited by 6 publications

(3 citation statements)

References 76 publications

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“…Consequently, separate rapid screening tools for swallowing and communication are highly advisable. To ensure monitoring of suspected rapid recovery or deterioration, repeat testing with validated rapid screening tools is essential [42]. …”

Section: Discussionmentioning

confidence: 99%

MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke

Flowers

Alharbi

Mikulis

et al. 2017

Cerebrovasc Dis Extra

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Background: Due to the high post-stroke frequency of dysphagia, dysarthria, and aphasia, we developed comprehensive neuroanatomical, clinical, and demographic models to predict their presence after acute ischemic stroke. Methods: The sample included 160 randomly selected first-ever stroke patients with confirmed infarction on magnetic resonance imaging from 1 tertiary stroke center. We documented acute lesions within 12 neuroanatomical regions and their associated volumes. Further, we identified concomitant chronic brain disease, including atrophy, white matter hyperintensities, and covert strokes. We developed predictive models using logistic regression with odds ratios (OR) and their 95% confidence intervals (95% CI) including demographic, clinical, and acute and chronic neuroanatomical factors. Results: Predictors of dysphagia included medullary (OR 6.2, 95% CI 1.5–25.8), insular (OR 4.8, 95% CI 2.0–11.8), and pontine (OR 3.6, 95% CI 1.2–10.1) lesions, followed by brain atrophy (OR 3.0, 95% CI 1.04–8.6), internal capsular lesions (OR 2.9, 95% CI 1.2–6.6), and increasing age (OR 1.4, 95% CI 1.1–1.8). Predictors of dysarthria included pontine (OR 7.8, 95% CI 2.7–22.9), insular (OR 4.5, 95% CI 1.8–11.4), and internal capsular (OR 3.6, 95% CI 1.6–7.9) lesions. Predictors of aphasia included left hemisphere insular (OR 34.4, 95% CI 4.2–283.4), thalamic (OR 6.2, 95% CI 1.6–24.4), and cortical middle cerebral artery (OR 4.7, 95% CI 1.5–14.2) lesions. Conclusion: Predicting outcomes following acute stroke is important for treatment decisions. Determining the risk of major post-stroke impairments requires consideration of factors beyond lesion localization. Accordingly, we demonstrated interactions between localized and global brain function for dysphagia and elucidated common lesion locations across 3 debilitating impairments.

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Section: Discussionmentioning

confidence: 99%

MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke

Flowers

Alharbi

Mikulis

et al. 2017

Cerebrovasc Dis Extra

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“…Failure of normal pharyngeal muscle function can also manifest as dysphagia (swallowing impairment), which is common in the immediate days following acute stroke (Brogan, Langdon, Brookes, Budgeon, & Blacker, 2014). Indeed, the occurrence of dysphagia in acute stroke is reported to be as high as 50% (Flamand-Roze, Cauquil-Michon, & Denier, 2012). Its presence is often accompanied by poor clinical outcomes, including longer hospitalization and higher mortality (Martino, Beaton, & Diamant, 2009).…”

Section: Introductionmentioning

confidence: 99%

Sleep‐disordered breathing in patients with stroke‐induced dysphagia

Estai

Walsh

Maddison

et al. 2020

Journal of Sleep Research

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This study examined the nature and characteristics of sleep-disordered breathing, including obstructive sleep apnea and central sleep apnea, in patients with post-stroke dysphagia, to determine the demographic, anthropometric and clinical variables that were associated with sleep-disordered breathing. Thirty-nine patients diagnosed with acute stroke (28 males and 11 females with a mean age of 72.3 ± 10.0 years) underwent overnight polysomnography (within 3.9 ± 1.6 days after admission). Sleep-disordered breathing was described by the apnea-hypopnea index and its obstructive and central components by the obstructive apnea-hypopnea index and central apnea-hypopnea index, respectively. Severity of dysphagia was assessed using the Mann Assessment of Swallowing Ability score. Severity of stroke and functional dependence were assessed by the National Institute of Health Stroke Scale and the modified Barthel index, respectively. Most of the cohort (87%) had moderate-to-severe dysphagia (Mann Assessment of Swallowing Ability of 143.2 ± 19.9). Sleep-disordered breathing (apnea-hypopnea index ≥ 5 events/hr) was present in 38 participants (97%) with a mean apnea-hypopnea index of 37.5 ± 24.4 events/hr. Sleep-disordered breathing was predominantly obstructive in nature, with a mean obstructive apnea-hypopnea index and central apnea-hypopnea index of 19.6 ± 15.7 and 11.4 ± 17.6 events/hr, respectively. Multivariate linear regression analyses showed that the apnea-hypopnea index was associated with sex (p = .0001), body mass index (p = .029) and the modified Barthel index (p = .006); the obstructive apnea-hypopnea index was associated with the Mann Assessment of Swallowing Ability (p = .006), sex (p = .004) and body mass index (p = .015) and had a nonlinear relationship with the modified Barthel index (p = .019); and the central apnea-hypopnea index was associated with sex (p = .027) and the modified Barthel index (p = .019). The present study showed that dysphagia severity was associated with obstructive sleep apnea severity and this association was independent of sex, modified Barthel index and body mass index.

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“…However, these models have shown low to moderate performance. Dysphagia, a symptom frequently observed in stroke patients, impacts an estimated 38.5 to 50% of individuals who have experienced a stroke [ 57 , 58 ]. Previous research has indicated that dysphagia serves as an independent risk factor for stroke patients with OSA [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review

Yang,

Lu,

Yang

2024

Syst Rev

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Background Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive cessation or reduction in airflow during sleep. Stroke patients have a higher risk of OSA, which can worsen their cognitive and functional disabilities, prolong their hospitalization, and increase their mortality rates. Methods We conducted a comprehensive literature search in the databases of PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, and CNKI, using a combination of keywords and MeSH words in both English and Chinese. Studies published up to March 1, 2022, which reported the development and/or validation of clinical prediction models for OSA diagnosis in stroke patients. Results We identified 11 studies that met our inclusion criteria. Most of the studies used logistic regression models and machine learning approaches to predict the incidence of OSA in stroke patients. The most frequently selected predictors included body mass index, sex, neck circumference, snoring, and blood pressure. However, the predictive performance of these models ranged from poor to moderate, with the area under the receiver operating characteristic curve varying from 0.55 to 0.82. All the studies have a high overall risk of bias, mainly due to the small sample size and lack of external validation. Conclusion Although clinical prediction models have shown the potential for diagnosing OSA in stroke patients, their limited accuracy and high risk of bias restrict their implications. Future studies should focus on developing advanced algorithms that incorporate more predictors from larger and representative samples and externally validating their performance to enhance their clinical applicability and accuracy.

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Tools and Early Management of Language and Swallowing Disorders in Acute Stroke Patients

Cited by 6 publications

References 76 publications

MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke

MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke

Sleep‐disordered breathing in patients with stroke‐induced dysphagia

Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review

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