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Detection of aspiration and swallowing disorder in older stroke patients: Simple swallowing provocation test versus water swallowing test,☆☆,

https://doi.org/10.1053/apmr.2000.9171Get rights and content

Abstract

Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Arch Phys Med Rehabil 2000;81:1517-9. Objective: To assess the sensitivity and specificity of a simple swallowing provocation test (SPT) and a water swallowing test (WST) in detecting aspiration pneumonia in elderly patients with stroke. Design: Retrospective comparative study involving a simple 2-step SPT and WST on all subjects. Participants: Twenty-six stroke patients with aspiration pneumonia (mean age, 72.1 ± 4.1yr) and 26 age-matched stroke patients without aspiration pneumonia (mean age, 69.4 ± 3.9yr). Interventions: The normal response to SPT was determined by inducing swallowing reflex within 3 seconds after water injection into the suprapharynx. In WST, subjects drank quantities of 10 and 30mL of water from a cup within 10 seconds. The subject who drank water without interruption—without evidence of aspiration—was determined as normal. Results: The sensitivity and specificity of first-step SPT for the detection of aspiration pneumonia were 100% and 83.8%, respectively. Those of the second-step SPT were 76.4% and 100%, respectively. The sensitivity and specificity of first-step WST using 10mL of water for the detection of aspiration pneumonia were 71.4% and 70.8%, respectively. Those of the second-step WST using 30mL of water were 72% and 70.3%, respectively. Conclusion: SPT is more useful than WST in differentiating patients predisposed to aspiration. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants

Twenty-six patients with aspiration pneumonia (11 men, 15 women; mean age ± standard deviation, 72.1 ± 4.1yr; mean body mass index [BMI], 19.4 ± 0.6kg/m2) and 26 controls without aspiration pneumonia (12 men, 14 women; mean age, 69.4 ± 3.9yr; mean BMI, 19.6 ± 0.5kg/m2) participated in the study. All subjects had a previous history of stroke. Varying degrees of cerebral atrophy, lacunar infarction, and old infarction were found in both groups by using cerebral computed tomography and magnetic

Discussion

The present study shows that the water-stimulated swallowing reflex is considerably impaired in patients with aspiration pneumonia when compared with the responses to swallowing provocation in control subjects without aspiration pneumonia. A greater volume of water was necessary to induce the swallowing reflex in patients with aspiration pneumonia than in the control subjects. In the controls, 0.4mL of water was sufficient to elicit swallowing; however, 2mL was insufficient to initiate

Conclusion

Because special equipment is not necessary to perform SPT, and because SPT can be performed without active patient cooperation, SPT should be preferred over WST in the clinical setting.

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    Supported by a grant from Mitsui Life Social Welfare Foundation of Japan.

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    Reprint requests to Shinji Teramoto, MD, San-no Hospital, International University of Health & Welfare, 8-5-35 Akasaka, Minato-ku, Tokyo, Japan 107-0052, e-mail: [email protected].

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