Ann Rehabil Med.  2014 Oct;38(5):612-619. 10.5535/arm.2014.38.5.612.

Cutoff Value of Pharyngeal Residue in Prognosis Prediction After Neuromuscular Electrical Stimulation Therapy for Dysphagia in Subacute Stroke Patients

• Park JM
• Yong SY
• Kim JH
• Jung HS
• Chang SJ
• Kim KY
• Kim H

• KMID: 2266495
• DOI: http://doi.org/10.5535/arm.2014.38.5.612

Abstract

OBJECTIVE
To determine the cutoff value of the pharyngeal residue for predicting reduction of aspiration, by measuring the residue of valleculae and pyriformis sinuses through videofluoroscopic swallowing studies (VFSS) after treatment with neuromuscular electrical stimulator (VitalStim) in stroke patients with dysphagia.
METHODS
VFSS was conducted on first-time stroke patients before and after the VitalStim therapy. The results were analyzed for comparison of the pharyngeal residue in the improved group and the non-improved group.
RESULTS
A total of 59 patients concluded the test, in which 42 patients improved well enough to change the dietary methods while 17 did not improve sufficiently. Remnant area to total area (R/T) ratios of the valleculae before treatment in the improved group were 0.120, 0.177, and 0.101 for solid, soft, and liquid foods, respectively, whereas the ratios for the non-improved group were 0.365, 0.396, and 0.281, respectively. The ratios of the pyriformis sinuses were 0.126, 0.159, and 0.121 for the improved group and 0.315, 0.338, and 0.244 for the non-improved group. The R/T ratios of valleculae and pyriformis sinus were significantly lower in the improved group than the non-improved group in all food types before treatment. The R/T ratio cutoff values were 0.267, 0.250, and 0.185 at valleculae and 0.228, 0.218, and 0.185 at pyriformis sinuses.
CONCLUSION
In dysphagia after stroke, less pharyngeal residue before treatment serves as a factor for predicting greater improvement after VitalStim treatment.

Keyword

Deglutition disorder; Dysphagia; Electric stimulation therapy; Pharyngeal residue; Cutoff value

MeSH Terms

Deglutition
Deglutition Disorders*
Electric Stimulation Therapy*
Humans
Prognosis*
Stroke*

Figure

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  Fig. 1 Aspiration is defined as presence of material below the vocal folds (double line). Penetration is defined as barium crossing the upper plane of the laryngeal aditus (single line), or the imaginary line from the arytenoid cartilages (short arrow) to the aryepiglottic fold (long arrow).

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  Fig. 2 Vallecular remnant area to total area ratio is defined as proportion of residue areas of valleculae (A) to their total space (B) viewed on lateral image of videofluoroscopic swallowing study.

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  Fig. 3 Pyriformis remnant area to total area ratio is defined as proportion of residue areas of pyriformis sinuses (A) to their total space (B) viewed on lateral image of videofluoroscopic swallowing study.

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  Fig. 4 ROC curve shows remnant area to total area (R/T) ratio to be a good screening test for the prediction of effectiveness of NMES therapy for dysphagia at valleculae (A) and pyriformis (B). ROC, receiver operating characteristic; NMES, neuromuscular electrical stimulation.

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