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Rehabilitation Practice and Science

Translated Title

腦中風患者吞嚥功能臨床評估可靠性之探討

Abstract

Although it has variable reliability, the bedside clinical swallowing evaluation (CSE) of dysphagia has long been accepted as the basic screening tool in the examination of the swallowing function of stroke patients. The purpose of this study was to define the reliability of the CSE by comparing it to the standard videofluoroscopic study of swallowing (VFSS). Thirty six stroke patients within a period of two years were included in this study, and all of them received the CSE and VFSS simultaneously. Three of them had a normal VFSS, whereas 21 (58%) aspirated during the VFSS examination. Ten of the people who aspirated had silent aspiration. Single clinical signs of dysphagia, including poor tongue movement, drooling, and facial muscle weakness, had unsatisfactory sensitivity and specificity, with a range of 55% to 72% in detecting their corresponding swallowing disorder in the VFSS. The sensitivity and specificity of detecting aspiration in the VFSS by a single clinical sign was around 70% to 78%. This rate rose markedly to a sensitivity of 90% and specificity of 93% when four factors, abnormal tongue movement, choking, wet voice, and delayed swallowing reflex, were taken into consideration together.In conclusion, the CSE is neither sensitive nor specific enough to replace the VFSS in the diagnosis and management of dysphagia. However, the combination of four clinical signs may provide a better and acceptable accuracy in detecting aspiration, especially when VFSS is unavailable.

Language

Traditional Chinese

First Page

175

Last Page

180

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