6. Four-quadrant Facial Function in Dysphagic Patients after Stroke and Healthy Controls
Hägg M.,Tibbling L. Neurology Research International Volume 2014, Article ID 672685, 5 pages.
Abstract as published
This study aims to examine any motility disturbance in any quadrant of the face other than the quadrant innervated by the lower facial nerve contralateral to the cortical lesion after stroke. Thirty-one stroke-afflicted patients with subjective dysphagia, consecutively referred to a swallowing centre, were investigated with a facial activity test (FAT) in all four facial quadrants and with a swallowing capacity test (SCT). Fifteen healthy adult participants served as FAT controls. Sixteen patients were judged to have a central facial palsy (FP) according to the referring physician, but all 31 patients had a pathological FAT in the lower quadrant contralateral to the cortical lesion. Simultaneous pathology in all four quadrants was observed in 52 % of stroke-afflicted patients with dysphagia; some pathology in the left or right upper quadrant was observed in 74 %. Dysfunction in multiple facial quadrants was independent of the time interval between stroke and study inclusion. All patients except two had a pathological SCT. All the controls had normal activity in all facial quadrants. In summary the majority of poststroke patients with dysphagia have subclinical orofacial motor dysfunction in three or four facial quadrants as assessed with a FAT. However, whether subclinical orofacial motor dysfunction can be present in stroke-afflicted patients without dysphagia is unknown.
Relevance to conditions
Dysphagia: Proof of existence of multi-quadrant facial paresis in all stroke patients, and the effectiveness of IQoro in treating.
Peer reviewed, Prospective, Cross-sectional.
To examine any motility disturbance after stroke in a quadrant of the face other than the quadrant innervated by the lower facial nerve contralateral to the cortical lesion.
46 adult patients: 31 after first stroke and 15 healthy controls.
The stroke group consisted of F=11, M=20, median age 67 (range 46–82 years).
11 patients had a cortical lesion on the right-hand side (RHS), 18 on the left-hand side (LHS) and 2 had a bilateral lesion.
Facial palsy (FP) at rest, was diagnosed by the referring physicians in 7 on RHS, 8 LHS and in 1 of the bilateral cases. FP at rest was not diagnosed in 15 patients.
The 15 healthy controls comprised F=6, M=9. Median age 66 (range 52–77 years)
Measurement and comparison of patients’ facial activity and swallowing ability.
- Facial Activity Test (FAT)
- Swallowing ability (using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec.
The majority of poststroke patients with dysphagia have subclinical orofacial motor dysfunction in three or four facial quadrants as assessed with a FAT. However, whether subclinical orofacial motor dysfunction can be present in stroke-afflicted patients without dysphagia is unknown.
Statistical significance of result
(p < 0.001) Pharyngeal sling force improvement.
(p < 0.001) Swallowing ability improvement.
IQoro training improves oropharyngeal dysphagia and facial paresis in patients with stroke irrespective of time to intervention, age or gender. The presence or absence of facial paresis had no effect on treatment outcomes.