Cerebrovascular Accident Clinical Trial
Official title:
Sonographic Assessment of Laryngeal Elevation in Cerebrovascular Accident Patients With Dysphagia
Ultrasonographic examination has long been used to assess the swallowing function. It has
the advantages of no ionizing radiation on examination and the possibility of using the real
food instead of the barium meal in testing. Thus, the subjects can be examined repeatedly
and in a more physiological status of swallowing. However, the ultrasonographic examination
is only used in assessing the oral phase of swallowing. It can accurately visualize the
tongue movement, measure the oral transit time of bolus, and sometimes the hypoid bone
motion, but has not been applied on the evaluation of pharyngeal phase of swallowing.
Physically, laryngeal elevation is an essential component of the swallowing movement on
pharyngeal phase. It ensures the occlusion of airway and opening of criopharymgeus muscle,
and thus prevents the aspiration. To evaluate the laryngeal elevation is crucial point in
managing the dysphagic patients.
The purpose of this project is to measure the laryngeal elevation in normal and in dysphagic
patients with cerebrovascular (CVA) accident using ultrasonographic techniques. This work
will include four group subjects. The first group consists of 20 young subjects (< 40
years); the second group consists of 20 age-matched normal subjects; the third group
consists of 20 CVA patients without swallowing problems, and the fourth group consists of 20
CVA patients with dysphagia, which was proven by VFSS. The laryngeal elevation is detected
by ultrasound with the transducer placing between the hyoid bone and thyroid cartilage. The
two markers are easily detected on sonogram because of the presence of acoustic shadow, a
specific character of bony structure on sonogram. The distance between the hyoid bone and
thyroid cartilage before and during swallowing is measures and compared among the groups.
The distance change of the patients with dysphagia is further compared with that defined by
VFSS. With the result of this study, we will understand the status of laryngeal elevation
during swallowing in normal and dysphagic subjects, and further determine the accuracy of
ultrasonographic measurement in measuring the laryngeal elevation. With this knowledge, we
might extend the usage of ultrasonographic examination on evaluating swallowing function.
Dysphagia is a common problem in rehabilitation medicine. To accurately evaluate its
disorder is crucial in managing this group patient. Videofluoroscopic examination of swallow
(VFSS) is generally regarded as the “gold standard” in the assessment of oropharyngeal
dysphagia, especially in the detection of laryngeal penetration or subglottic aspiration.
However, its limitations are widely acknowledged. VFSS cannot be performed widely because of
its radiation exposure, is a single time measure, where as aspiration may be a variable
phenomenon. Moreover, VFSS may over diagnose the disorder of swallowing function since the
unflavored barium could disturb deglutition ability of the patients, particularly in those
who having impaired cognitive function. As a result, the researchers have sought for more
reliable bedside evaluation methods to detect aspiration. Various bedside clinical
evaluations such as neurological examination, water swallow test, and swallowing provocation
test have been used in identifying predicting or aspiration. However, when considered
against the gold standard VFSS, prediction rate for aspiration was still unsatisfactory.
Seeking for more non-invasive and objective method of evaluating swallowing function is
continuing by many researches.
Ultrasonographic examination has long been used to assess the swallowing function. It has
the advantages of no ionizing radiation on examination and the possibility of using the real
food instead of the barium meal in testing. Thus, the subjects can be examined repeatedly
and in a more physiological status of swallowing. However, the ultrasonographic examination
is only used in assessing the oral phase of swallowing. It can accurately visualize the
tongue movement, measure the oral transit time of bolus, and sometimes the hypoid bone
motion, but has not been applied on the evaluation of pharyngeal phase of swallowing.
Physically, laryngeal elevation is an essential component of the swallowing movement on
pharyngeal phase. It ensures the occlusion of airway and opening of criopharymgeus muscle,
and thus prevents the aspiration. To evaluate the laryngeal elevation is crucial point in
managing the dysphagic patients.
The purpose of this project is to measure the laryngeal elevation in normal and in dysphagic
patients with cerebrovascular (CVA) accident using ultrasonographic techniques. This work
will include four group subjects. The first group consists of 20 young subjects (< 40
years); the second group consists of 20 age-matched normal subjects; the third group
consists of 20 CVA patients without swallowing problems, and the fourth group consists of 20
CVA patients with dysphagia, which was proven by VFSS. The laryngeal elevation is detected
by ultrasound with the transducer placing between the hyoid bone and thyroid cartilage. The
two markers are easily detected on sonogram because of the presence of acoustic shadow, a
specific character of bony structure on sonogram. The distance between the hyoid bone and
thyroid cartilage before and during swallowing is measures and compared among the groups.
The distance change of the patients with dysphagia is further compared with that defined by
VFSS. With the result of this study, we will understand the status of laryngeal elevation
during swallowing in normal and dysphagic subjects, and further determine the accuracy of
ultrasonographic measurement in measuring the laryngeal elevation. With this knowledge, we
might extend the usage of ultrasonographic examination on evaluating swallowing function.
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Observational Model: Case Control, Primary Purpose: Screening, Time Perspective: Cross-Sectional
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