Case History

Question 0

What is the effect of a left hemisphere stroke on swallowing?

Answer 0

Predominant impairment = oral stage

May be swallow apraxia

May be delay in initiating swallow

Mild delay in pharyngeal triggering

Usually normal pharyngeal swallow

Question 1

What is the effect of a brainstem stroke on swallowing?

Answer 1

Pharyngeal swallow may be absent

Oral stage may be functional

Delayed pharyngeal swallow

Reduced laryngeal elevation

Question 2

What is the effect of a right hemisphere store on swallowing?

Answer 2

Compromise pharyngeal stage resulting in aspiration

May be mild oral transit delay

Mild delay in triggering the pharyngeal swallow

Mild slowness in elevating larynx

Often have trouble integrating therapy or compensatory strategies into oral feeding because of cognitive impairments and relative inattention.

Therefore generally take longer to resume oral feeding than left hemisphere stroke patients

Question 3

What is the effect of bilateral or multiple strokes on swallowing?

Answer 3

Often have higher incidence or greater severity of swallowing abnormalities

Oral stage:
Repetitive tongue movements (tongue pumping)
Prolonged oral transit times of 5 seconds or more

Pharyngeal stage:
Reduced laryngeal elevation and glottis closure resulting in penetration
Unilateral pharyngeal weakness leading to pooling in the pyriform sinuses on affected side

Attention may be reduced so therapy is often not as effective