Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tr
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ORIGINAL ARTICLE
Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tractography study Sung Ho Jang1 · Jun Lee2 · Min Son Kim1 Received: 18 May 2020 / Accepted: 24 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We investigated the capacity for dysphagia prognosis prediction using diffusion tensor tractography (DTT) to assess the state of the corticobulbar tract (CBT) during the initial period following lateral medullary infarction (LMI). Twenty patients with LMI and 20 control subjects were recruited for this study. The patients were classified into two subgroups: subgroup A (16 patients with nasogastric tube required for six months or less after LMI onset) and subgroup B (4 patients with nasogastric tube required for more than six months after onset). DTT was used to reconstruct the CBTs of each patient and control subject, and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained. In the affected hemisphere, the FA value of the CBT was significantly lower in subgroup B than in subgroup A and the control group (p 0.05). However, PAS score (subgroup A: mean 3.2 ± 2.6; subgroup B: mean 7.2 ± 0.5) was significantly higher and FOIS score (subgroup A: mean 4.4 ± 1.8; subgroup B: mean 1.2 ± 0.5) was significantly lower in subgroup B than in subgroup A (p 0.05). All patients underwent swallowing therapy (30 min per session, twice a day, five days per week) performed by occupational therapists. Swallowing therapies included indirect and/or direct methods to facilitate the sensory and motor functions of the orofacial and laryngopharyngeal muscles. Patients were taught compensatory strategies and exercises for swallowing including the Shaker exercise, Mendelsohn maneuver, head rotation maneuver, chin-tuck maneuver, and effortful swallowing [37–43]. Neuromuscular electrical stimulation was applied to the suprahyoid and/or infrahyoid muscles (30 min per session and 5 sessions per week) [44]. When patients showed clinical improvement of dysphagia symptoms, follow-up VFSS was performed. When a PAS score was
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