Videofluoroscopic Profiles of Swallowing and Airway Protection Post-traumatic Cervical Spinal Cord Injury
Videofluoroscopic Profiles of Swallowing and Airway Protection Post-traumatic Cervical Spinal Cord Injury
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吞咽和气道保护后颈脊髓损伤的电视透视图
DOI：
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
L. Cherney
中科院分区：
文献类型：
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作者：
Valerie K Hamilton;Laura L. Pitts;Erin A Walaszek;L. Cherney
创伤性颈脊髓损伤（tCSCI）幸存者吞咽的视频透视分析主要限于病例报告/系列和定性观察。为了阐明tCSCI后吞咽困难的生理学破坏，这项前瞻性观察性研究分析了20名tCSCI幸存者的视频透视吞咽研究（以每秒30帧的速度记录）。正常参考的吞咽时间或位移的措施，和校准的面积测量喉前庭关闭（LVC）进行了探讨与严重程度的吸入或咽残留物。通过损伤程度、手术干预、气管造口术状态以及与临床床旁评估的关系，比较了视频透视的性能。tCSCI后吞咽困难的特征是咽部收缩减少、舌骨抬高延迟和LVC受损。舌骨偏移和咽食管段（PES）开口的程度降低并不明显，仅存在于约一半或更少的样本中。10名参与者吸气，94%的吸气事件是无声的。误吸的严重程度与咽部收缩和咽部通过时间延长显著相关。吞咽后残留物与延迟PES扩张/闭合和延长咽部通过相关。关于床边咽相完整性的临床推断是有限的;然而，EAT-10评分显示有希望作为tCSCI后吞咽困难的辅助临床标志物。这项探索性研究进一步描述了tCSCI后吞咽困难的病理生理学基础，以促进缺陷特异性康复和功能恢复。
Videofluoroscopic analyses of swallowing in survivors of traumatic cervical spinal cord injury (tCSCI) have been largely limited to case reports/series and qualitative observations. To elucidate the disrupted physiology specifically underlying dysphagia post-tCSCI, this prospective observational study analyzed videofluoroscopic swallow studies (recorded at 30 frames per second) across 20 tCSCI survivors. Norm-referenced measures of swallow timing or displacement, and calibrated area measures of laryngeal vestibule closure (LVC) were explored in relation to the severity of aspiration or pharyngeal residue. Videofluoroscopic performance was compared by injury level, surgical intervention, tracheostomy status, and in relation to clinical bedside assessments. Reduced pharyngeal constriction, delayed hyoid elevation, and impaired LVC characterized post-tCSCI dysphagia. Reduced extent of hyoid excursion and of pharyngoesophageal segment (PES) opening were not as prominent, only present in approximately half or less of the sample. Ten participants aspirated and 94% of aspiration events were silent. Severity of aspiration significantly correlated with pharyngeal constriction and prolonged pharyngeal transit times. Post-swallow residue correlated with delayed PES distention/closure and prolonged pharyngeal transit. Clinical inference regarding the integrity of the pharyngeal phase at bedside was limited; however, EAT-10 scores demonstrated promise as an adjuvant clinical marker of post-tCSCI dysphagia. This exploratory study further describes the pathophysiology underlying post-tCSCI dysphagia to promote deficit-specific rehabilitation and functional recovery.