Clinical Comparative Analysis Of Patients With Dysphagia Between Bulbar Palsy And Pseudobulbar Palsy After Stroke

Objective:To compare the general clinical data and abnormal swallowing manifestations of patients with dysphagia between bulbar palsy and pseudobulbar palsy after stroke,and analyze the factors related to prognosis and differences in clinical efficacy after 2 weeks of treatment,and explore the reasons for their different sensitivity to rehabilitation treatment.Method:We collected the clinical data of 63 patients with swallowing dysfunction after bulbar palsy and 133 patients with swallowing dysfunction after pseudobulbar palsy who were admitted to the Department of Rehabilitation Medicine from January 2018 to December 2020.Then we compared the general clinical data and abnormal swallowing manifestations of the two groups.According to the results of the Water Swallow Test(WST)after two weeks of treatment,patients were divided into recovery group and non-recovery group and their abnormal swallowing manifestations were compared.Then we established Logistic regression models to find prognostic risk factors.Before and after treatment,WST was used to assess the degree of dysphagia between the two groups,and to evaluate the difference in the efficacy of swallowing treatment between the two groups.Result:①There were statistically significant differences between the two groups in the hypertension,past stroke history,speech abnormalities,depression,strong crying and strong laughter,Barthel index,Berg balance scale,and WST classification at admission.②There were statistically significant differences in the abnormal mouth opening grading,abnormal lip closure,abnormal tongue movement,abnormal retention/remaining in the oral cavity,weakened or disappeared pharyngeal reflex on one side,weakened or disappeared pharyngeal reflex on both sides,abnormal laryngeal elevation,abnormal retention/remaining of epiglottic valley,abnormal retention/residual of pear shape fossa,dominant aspiration recessive aspiration,abnormal opening of UES between the bulbar palsy group and the pseudobulbar palsy group.③There were statistically significant differences in the abnormalities of UES opening and recessive aspiration between the bulbar palsy recovery group and the non-recovered group.There were statistically significant differences in the abnormal mouth opening grading,abnormal tongue movement,abnormal retention/remaining in the oral cavity,and slow esophageal motility between the pseudobulbar palsy recovery group and the non-recovered group.④The abnormal mouth opening grading(OR=0.171,P=0.039)and abnormal tongue movement(OR=0.196,P=0.021)had a predictive effect on the outcome of swallowing function in the pseudobulbar palsy group after 2 weeks of treatment.⑤After 2 weeks of treatment,the percentages of patients with bulbar palsy and pseudobulbar palsy who had good grades of WST increased.The total apparent efficiency rate in the bulbar palsy group was 6.3%,which was lower than 21.1%in the pseudobulbar palsy group,and the total effective rate was 79.4%,which was lower than 93.2%in the pseudobulbar palsy group.The differences were statistically significant.Conclusion:①The general clinical data of the two groups of patients were different but had no predictive effect.②The abnormal manifestations of dysphagia of the two groups were distributed in the oral stage,pharyngeal stage,and esophageal stage.The bulbar palsy group was mainly distributed in the pharyngeal stage,and the pseudobulbar palsy group was mainly distributed in the oral stage.③The abnormal mouth opening grading and abnormal tongue movement had a predictive effect on the outcome of swallowing function in the pseudobulbar palsy group after 2 weeks of treatment,which were the risk factors.④After 2 weeks of treatment,the swallowing comprehensive rehabilitation therapy had improved swallowing disorders in both groups.The pseudobulbar palsy group had better sensitivity to swallowing rehabilitation therapy and the degree of improvement was greater.