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ObjectiveTo investigate the clinical characteristics of dysphagia after brainstem stroke, and rehabilitation effect and influencial factors for it. MethodsA retrospectively analysis was conducted in patients who were diagnosed as dysphagia after brainstem stroke in the Beijing Bo'ai Hospital from April, 2018 to December, 2021. The following data were collected: the general information (gender, age, course of disease, and time of treatment), the result of videofluoroscopic swallowing study (VFSS), the Dysphagia Severity Scale (DSS) score before and after treatment, the scores of Fugl-Meyer Assessment (FMA), FMA-Balance (FMA-B), National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI), Mini-Mental State Examination (MMSE), and whether oral feeding. Based on the result of VFSS, all patients were divided into non-cricopharyngeal achalasia group (control group) and cricopharyngeal achalasia group (observation group). ResultsA total of 60 patients were collected, with 29 in the control group and 31 in the observation group. The scores of FMA, FMA-B, BI and MMSE were higher (|t| > 3.281, P < 0.01), and the NIHSS score was lower (t = 4.390, P < 0.001) in the observation group than in the control group. Before treatment, the score of DSS was significantly lower in the observation group than in the control group (t = 5.785, P < 0.001); after treatment, the scores improved in both groups (|t| > 5.387, P < 0.001), and no significant difference was found between two groups (t = 1.675, P = 0.099); however, the d-value was more in the observation group than in the control group (t = -2.729, P = 0.008). There was no significant difference in the rate of oral feeding (χ² = 2.742, P = 0.098). In the control group, there were differences in the scores of NIHSS, FMA-B, BI and DSS between patients with oral feeding and those with nasal feeding (|t| > 2.429, P < 0.05); however, no significant difference was found in all factors in the observation group (P > 0.05). The DSS score was the influence factor of oral feeding in the control group (OR = 3.947, 95%CI 1.361 to 11.450, P = 0.012), and no influencing factor was found in the observation group. ConclusionAmong the patients with dysphagia after brainstem stroke, less accompanying disorders and more severe dysphagia were found in those with cricopharyngeal achalasia. All patients improved in dysphagia after treatment, and the rehabilitation effect of cricopharyngeal achalasia was better. The score of DSS relates with oral feeding in non-cricopharyngeal achalasia patients, and there was no specific influencing factor in cricopharyngeal achalasia patients.
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Objective:To analyze the factors influencing dysphagia after an injury to the cervical spinal cord (CPCI) to provide a basis for clinical screening and intervention.Methods:A total of 110 CPCI patients with dysphagia were divided into a severe dysphagia group ( n=19), a mild dysphagia group ( n=35), and a control group ( n=56) according to their functional oral intake scale scores. Data on gender, age, level of injury, degree of damage, duration of injury, causes of injury, surgical mode, tracheotomy status, occurrence of pneumonia and pharynx swelling were collected. Univariate and multivariate logistic regressions were evaluated to identify factors affecting swallowing. Results:The regressions highlighted age, the severity of the spinal cord injury, tracheotomy status, and the occurrence of pneumonia and pharyngeal swelling during hospitalization as the best predictors of swallowing difficulties. Multifactoral logistic regression analysis revealed that undergoing tracheotomy and catching pneumonia during hospitalization were major risk factors for severe dysphagia.Conclusions:Tracheotomy and pneumonia during hospitalization are useful predictors of severe dysphagia after a cervical spinal cord injury.
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@#Objective To explore the factors related to the recovery of nil per os (NPO) patients after stroke by retrospective data analysis, and to establish a predictive model.Methods The information of demographics, evaluation and treatment of 141 stroke patients admitted to the Hearing and Language Department in Beijing Bo'ai Hospital from April, 2017 to November, 2020 were selected. The predictive model was established by univariate analysis and Logistic regression. The fitting degree and discriminant validity of the model were evaluated by Hosmer-Lemeshow (H-L) test and receiver operating characteristic (ROC) curve. Other 121 patients with post-stroke dysphagia from December, 2020 to November, 2021 were used as the validation set to verify the model.Results For univariate analysis, National Institute of Health Stroke Scale (NIHSS) score, drinking water test results, autonomous cough ability, cough after swallowing, movement ability of tongue and jaw, and electrical stimulation treatment were significantly associated with the outcome (H=65.803, χ2 > 4.623, P<0.05). Multivariate Logistic regression analysis showed that NIHSS score (X1, OR=0.772, 95%CI 0.64 to 0.82, P<0.001), spontaneous cough ability (X2, OR=5.116, 95%CI 1.28 to 20.41, P=0.021), and electrical stimulation during treatment (X3, OR=94.718, 95%CI 5.65 to 1589.26, P=0.002) were independent factors for the outcome of swallowing function. Thus, the predictive model was P=11+e−(2.368−0.325X1+1.632X2+4.551X3) P = 1 1 + e - ( 2.368 - 0.325 X 1 + 1.632 X 2 + 4.551 X 3 ) , which was well fitting (P=0.845), with the largest area under curve (0.884). The overall accuracy of the model in the validation set was 91.7%.Conclusion The patients with dysphagia would like to recover well if he/she was with lower NIHSS scores and normal autonomous cough ability; meanwhile, the addition of electrical stimulation therapy in comprehensive rehabilitation may be helpful. A predictive model has been established, which needs a further research.
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Apraxia of speech (AOS) is a motor speech disorder presented with characteristic speech performance and related brain loca-tion. This article reviewed the characteristic speech performance of AOS and common assessments, discussed the mechanism and provided neurological bases of AOS in order to understand the relationship between speech performance and imaging.
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@#Apraxia of speech (AOS) is a motor speech disorder presented with characteristic speech performance and related brain location.This article reviewed the characteristic speech performance of AOS and common assessments, discussed the mechanism and provided neurological bases of AOS in order to understand the relationship between speech performance and imaging.
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Objective To analyze the characteristic of tuberculous encephalitis following with dysphagia. Methods The characteristic of the patient was analyzed, and the signs and symptoms were inconsistent. And it was different with neuro dysphagia. Videofluoroscopic swal-lowing study was used to further examine. Results The cause of the patient's dysphagia was confirmed as tracheoesophageal fistula. Conclu-sion It exists clinically that brain lesion accompanied with constructional dysphagia without neurogenic dysphagia.
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@#As the diagnosis and treatment levels increased, the cure rate and lifetime of the patients with breast cancer improved. In China,surgery and drug treatment received more attention, but the overall rehabilitation was ignored. This article summarized the status of breast cancer patients's rehabilitation in lymphoedema, upper limb dysfunction, psychological problem, sexual dysfunction, childbirth trouble,dystrophy, follow-up visit and family-society support, and so on.
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@# Naming refers to broad nerve network, the cerebral location of naming is not clearly so far. It is a main measure to study the mechanism of naming by combining the symptoms and the imaging examination of aphasic patients. Meanwhile, it is also a focus of research in the field of neuropsychology. Many models on naming were produced. In this article, the authors reviewed the previous research fruits on naming and summarized some useful neuroanatomical pathways, cortex areas related to naming such as fusiform gyrus, angular gyrus, etc., and the most influential theories in the field of neuropsychology: namely lexicon system and lexical access theories.
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@#This article would review the general symptoms of anomia and the classification of anomia based on the clinical characteristics, including word production anomia, word selection anomia, semantic anomia, category-specific anomia, modality-specific anomia.
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@#This article would review the general symptoms of anomia and the classification of anomia based on the clinical characteristics, including word production anomia, word selection anomia, semantic anomia, category-specific anomia, modality-specific anomia.
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@#Objective To survey the kinetic function of articulating organs in children with cerebral paralysis.Methods The kinetic characteristics of articulating organs in 115 cerebral paralysis children aged 2～6 were observed,including frequency of respiration,stability of respiration,if there was reverse respiration,whether the respiration of mouth and nose was separated,the longest articulating and expiration time,original reflections of mouth and so on.Results and Conclusion The kinetic function of children's articulating organs was limited just like that of their limb.So their kinetic characteristics of articulative organs differed from adults's and normal children's.
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@#The standard of speech disability used in Chinese Second Disability Sampling Survey is introduced in the paper,including classification,screening,survey instrument,diagnose,cause analysis and rehabilitation advice.