Development and evaluation of predictive indices in neurogenic dysphagia

Abstract

The aim of this thesis was to establish if there is a simple clinical evaluation for aspiration in neurogenic dysphagia. It is likely that aspiration of food or fluid will cause reflex bronchoconstriction and consequential lung volume changes. This will lead to a ventilation perfusion mis-match, hypoxia and ultimately oxygen desaturation.

It further aimed to explore the mechanism of the “swallow/breathe” relationships in a neurogenic dysphagia in patients with multiple neurological conditions. A prospective, controlled single blind study was undertaken. Participants were assessed pre and post videofluoroscopy with spirometry and continuously with pulse oximetry during the videofluoroscopy.

43/76 participants were seen to aspirate on videofluoroscopy. Pulse oximetry had a 88.4% sensitivity and 54.5% specificity at detecting aspiration or lack of it. A CHAID analysis was used to develop a sequence fitting algorithm. Using oxygen desaturation, snoring and collar size as variables an 80% sensitivity and 80% specificity was found.

A second study was undertaken observing oxygen saturation while in 10 participants (5 aspirators and 5 non aspirators). It found that aspirating participants desaturate more frequently than non aspirating participants (p = .008), for longer periods of time (p = .008).

This research further suggests that monitoring of nocturnal oxygen saturation levels, in people who have had stroke may provide a strong indicator of the presence of aspiration or lack of it.

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