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PHARYNGEAL SWALLOWING RESPONSE IN INDIVIDUALS AFTER ISCHEMIC STROKE: A PILOT STUDY

Resumo

INTRODUCTION: The onset site of the Pharyngeal Swallowing Response (PSR) provides information about the sensory motor model of swallowing. Absence or longer duration of this process is common in the post-stroke population. OBJECTIVE: To identify the brain injury and the location of the PSR in post-stroke individuals. METHODOLOGY: Cross-sectional, prospective, quantitative study. Twelve patients with mean age 68.58 (±10.07), 5 women and 7 men, were evaluated. Included subjects ≥ 60 years old; confirmed ischemic stroke, responsive to perform videofluoroscopy (VDF). Pathologies that could cause dysphagia were excluded. During VDF, swallowing of 10 ml of extremely thickened food consistency was observed. The VDF and stroke images were analyzed by two speech pathologists and two neurologists. Lesion location was subdivided into: tentorial/supratentorial; cortical/subcortical and/or deep; right and/or left sides. A 4-point scale was used to identify the location of the PSR: 0 - posterior mandibular angle; 1 - epiglottic vallecula 2 - hypopharynx 3 - piriform recesses. RESULTS: Five patients with PSR in posterior mandibular angle, 3 (25.0%) supratentorial lesion; 1 (8.3%) supratentorial/infratentorial and 1 (8.3%) infratentorial. Five patients with PSR in epiglottic vallecula, 4 (33.3%) supratentorial lesion, 1 (8.3%) supratentorial/infratentorial. Two patients with PSR in piriform recesses, 1 (8.3%) supratentorial/infratentorial and 1 (8.3%) infratentorial. PSR and cortical/subcortical lesion: five patients had PSR in the posterior mandibular angle, 1 (8.3%) deep lesion; 2 (16.7) cortical/deep; 1 (8.3%) cortical/subcortical and 1 (8.3%) cortical. Five patients had PSR in epiglottic vallecula, 1 (8.3%) deep lesion; 1 (8.3%) cortical/deep; 2 (16.7%) cortical/subcortical and 1 (8.3%) cortical. Two patients with PSR in piriform recesses, 1 (8.3%) deep lesion and 1 (8.3%) cortical. PSR and laterality of the lesion: five patients with LRI in the posterior mandibular angle, 3 (25.0%) lesion on the left; 1 (8.3%) right; 1 (8.3%) bilateral. Five patients with PSR in epiglottic vallecula, 1(8.3%) lesion left and 4 (33.3%) right. The PSR in piriform recesses, 2 (16.7%) both with left lesion. CONCLUSION: This pilot study allowed us to identify the site of the PSR and the location of the encephalic lesion. A larger sample would be needed to understand the relationship between lesion location and its impact on swallowing physiology.