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Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke

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Abstract

Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This study was funded by the National Research Foundation of the Korean Government (NRF-2022R1A2B5B02001673).

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Authors and Affiliations

  1. Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea

    Sung-Bom Pyun

  2. Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea

    Jei Hak Myung & Sung-Bom Pyun

  3. Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea

    Sung-Bom Pyun

Authors
  1. Jei Hak Myung
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Contributions

Conceptualization (S-BP), methodology (S-BP, JHM), data curation (JHM), formal analysis (JHM), investigation (S-BP, JHM), projection administration (S-BP), validation (S-BP, JHM), writing the original draft (JHM); and critical review and editing (S-BP).

Corresponding author

Correspondence to Sung-Bom Pyun.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Formal consent was not required for this type of study.

Informed Consent

This study was approved by the Institutional Review Board of Korea University Anam Medical Center (no. 2021AN0151) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was waived owing to the retrospective nature of the study.

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Myung, J.H., Pyun, SB. Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke. Dysphagia 38, 227–235 (2023). https://doi.org/10.1007/s00455-022-10458-w

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