The abnormal swallowing modes in videofluorographic study after stroke

Objective:To prove the hypothesis that there may be different swallowing modes in dysphagia stroke patients.Method:Consecutive 80 dysphagic patients underwent videoflouroscopy drinking 5ml 60% W/V liquid barium. Height percent of larynx raise was calculated by the vertical excursion of air volume in the main bronchus according to its position at rest.Result:There were 3 swallowing modes.Mode 1: There were 7 male patients presenting abnormal oral swallowing mainly injured tongue movement. The pharyngeal swallowing did not present difficulties. Barium couldn′t be push backward by the tongue and fell into pharynx by the gravity. All the patients had aspiration because of delayed swallow.Mode 2: In this mode,there were two subtypes named group A and B. Of group A,hyoid elevation decreased(66.31%±13.46%) with significantly delayed pharyngeal swallowing(0.08s±0.104s). Delayed swallowing was the main cause of aspiration. Of group B,hyoid-laryngeal complex elevation were significantly decreased (45.38%±17.80%) which made short laryngeal closure(0.03s±0.015s) and obvious aspiration. Mode 3: Total 15 patients presented divergent movement of hyoid and larynx with no or light injured oral phase. The hyoid movement triggered in time or delayed lightly(0.024s±0.03s) with sufficient excursion,while larynx raise delayed for 1.34s±2.27with decreased excursion 26.74%±12.72%. Larynx closure time was 0.07s±0.03s. Aspiration happened in all patients.Conclusion:Different swallowing modes in stroke patients may be helpful to identify the main cause in swallow,which could facilitate the management.