Voluntary Cough and Swallowing Function Characteristics of Acute Stroke Patients Based on Lesion Type

Objective: To investigate the relation between voluntary cough and swallowing functions according to the type of lesion in patients with acute stroke. Design: Cross-sectional study. Setting: University rehabilitation hospital. Participants: Acute stroke patients with dysphagia symptoms (N=397). Interventions: Not applicable. Main Outcome Measures: A peak cough flow meter was used to measure voluntary coughing ability. Swallowing function was evaluated using the functional dysphagia scale and the penetration-aspiration scale based on the results of a videofluoroscopic swallowing study. Stroke lesions were divided into one of the following 3 categories: cortical, subcortical, and brainstem. These evaluations were performed within 2 weeks after stroke onset. Results: Of the enrolled 397 patients, 207 patients were classified as cortical stroke, 106 patients were classified as subcortical stroke, and 84 patients were classified as brainstem stroke. Among the subscores of the functional dysphagia scale, the amount of pharyngeal residue negatively correlated with peak cough flow meter results across all stroke lesion types. In the brainstem lesion, peak cough flow and penetration-aspiration scale scores were high compared with other lesions, but these 2 functions did not show a correlation. Conclusions: This study revealed that large amounts of pharyngeal residue correlated with weak voluntary cough ability in all stroke lesion groups. We also showed a discrepancy between 2 functions in the brainstem lesion group. Our results suggest that voluntary coughing exercises could be a helpful therapeutic option for dysphagia to prevent pulmonary complications in some types of patients with stroke. (C) 2015 by the American Congress of Rehabilitation Medicine