Comparison of sequential swallowing in patients with acute stroke and healthy adults

Arch Phys Med Rehabil. 2009 Nov;90(11):1860-5. doi: 10.1016/j.apmr.2009.05.014.


Objectives: To compare hyolaryngeal complex (HLC) movement and leading-edge-of-the-bolus location patterns of sequential swallowing in patients with stroke and healthy adults, and to determine whether these patterns affect swallowing safety.

Design: Between-groups comparison.

Setting: Veterans hospital.

Participants: Consecutively admitted patients with acute unilateral supratentorial stroke (right hemisphere damage, n=13; left hemisphere damage, n=16) and age-matched healthy participants (n=25).

Interventions: Not applicable.

Main outcome measures: HLC movement pattern, bolus location, Penetration-Aspiration (P-A) Scale score.

Results: No significant group differences were observed for HLC movement pattern, bolus location, and P-A Scale score. Specific HLC movement patterns and bolus location were not associated with a higher P-A Scale score. A significant correlation between HLC movement pattern and bolus location was observed. Bolus location was typically inferior to the valleculae between swallows when the HLC was partially elevated. Across all groups, P-A Scale scores were significantly higher during sequential swallowing than single swallows.

Conclusions: HLC movement pattern and bolus location do not appear related to airway invasion, at least in persons without significant dysphagia. Given higher P-A Scale scores during sequential swallowing as compared with single swallows, sequential swallowing should always be evaluated in all patients.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Disease
  • Aged
  • Analysis of Variance
  • Case-Control Studies
  • Deglutition Disorders / diagnostic imaging
  • Deglutition Disorders / physiopathology*
  • Female
  • Fluoroscopy
  • Hospitals, Veterans
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Stroke / physiopathology*