Screening of Dysphagia Via Ultrasonography in Patients With Stroke
Condition: Dysphagia, Oropharyngeal; Stroke
MeSH terms: Deglutition Disorders; Stroke
Study type: Interventional

Summary: 
      Oropharyngeal dysphagia is commonly seen in patients with stroke. Clinical assessment may be
      used to evaluate dysphagia in patients with stroke however reliability of this method is
      controversial and videofluoroscopic study is still considered as gold standard. However,
      exposure to radiation, necessity for a experienced practitioner, an expensive device, and
      swallowing contrast agents are disadvantages of videofluoroscopy. Ultrasonography, on the
      other hand, is a cheap, noninvasive device which may demonstrate tongue and laryngeal
      movement dynamically. In this manner, this study aims to evaluate whether ultrasound can
      assess dysphagia in patients with hemiplegia accurately.
    

Detailed description: 
      For a safe swallowing tongue muscles must function properly and larynx should replace
      superoanterior to close trachea via stretching cricopharyngeal muscle. In this context,
      approximation of thyroid cartilage and larynx is important for swallowing. These mechanisms
      are impaired in stroke, Parkinson's disease, traumatic brain injury, and neuromuscular
      disorders thus resulting oropharyngeal dysphagia. Clinical examination may be used for
      assessing dysphagia in those patients however reliability of this method is controversial and
      videofluoroscopic study is considered as gold standard for assessing dysphagia. Ultrasound is
      used to assess swallowing functions since 1970s however, the studies commonly focused on
      tongue thickness and functions. Due to advances in technology besides tongue thickness,
      ultrasonography may practically demonstrate how larynx and thyroid cartilage approximate and
      hor larynx moves anteriorly. In literature, three methods came to forefront as evaluation
      methods for dysphagia: 1) approximation of thyroid cartilage and hyoid bone (THA), 2) tongue
      thickness in rest (TT), and 3) hyoid bone anterior replacement (HAR). In previous studies,
      the efficiency of THA for assessing dysphagia via videofluoroscopic study has been
      demonstrated. However other methods have not been evaluated in dysphagic patients with
      stroke. Ultrasonography, as a cheap, portable and non-invasive method, is a promising for
      assessing dysphagia in patients with stroke. In this context, this study aims to test the
      reliability and efficacy of these three methods via ultrasound in dysphagic stroke patients
      and test the performance of ultrasound compared to videofluoroscopy.
    

Intervention name(s): Ultrasonographic study; Videofluoroscopic study temporal parameters; Videofluoroscopic study distance parameters
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): Thyroid hyoid approximation and hyoid anterior replacement during swallowing. Tongue thickness in rest.; Glossopalatine junction opening and closing time, velopharyngeal junction opening and closing time, laryngeal vestibule opening and closing time, upper esophageal sphincter opening and closing time in seconds.; Hyoid bone horizontal and vertical replacement, thyroid-hyoid approximation (THA) in millimeters.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Single group
Masking: Single (Outcomes Assessor)
Primary purpose: Diagnostic
Keywords: Hemiplegia; Dysphagia; Ultrasound; Videofluoroscopy