Dysarthria and Dysphagia in Traumatic Spinal Cord Injury: Frequency and Comorbidity in a Cross-Sectional Study
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Abstract
Objective: To determine the frequency, comorbidity, and relationship between dysarthria and dysphagia in patients with tSCI.
Methods: A descriptive-analytical cross-sectional study was conducted, enrolling 61 patients with tSCI from rehabilitation centers in Tehran, Iran, between January and September 2024. Dysarthria and dysphagia were assessed using the Persian-adapted versions of the Frenchay Dysarthria Assessment (FDA) and the Northwestern Dysphagia Patient Check Sheet (NDPCS), respectively. Logistic regression analysis was employed to evaluate the association between these conditions, with odds ratios (ORs) calculated to quantify the strength of the relationship.
Results: Dysarthria was observed in 87% of participants, with mixed dysarthria being the most prevalent subtype (34%). Dysphagia was identified in 49% of participants, of whom 49% exhibited both disorders concurrently. Logistic regression analysis indicated that patients with dysarthria were approximately nine times more likely to experience dysphagia (OR = 9.69, p < 0.05), even after adjustments for weight and gender.
Conclusion: This study underscores the high prevalence and significant comorbidity of dysarthria and dysphagia in patients with tSCI, with dysarthria identified as a robust predictor of dysphagia. These findings highlight the necessity of concurrent assessment and integrated rehabilitation approaches targeting both disorders to improve patient outcomes and quality of life.
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2. Rahimi-Movaghar V, Saadat S, Rasouli MR, Ganji S, Ghahramani M, Zarei M-R, et al. Prevalence of spinal cord injury in Tehran, Iran. The journal of spinal cord medicine. 2009;32(4):428-31.
3. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clinical epidemiology. 2014:309-31.
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5. Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respiratory care. 2006;51(8):853-70.
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8. Harkema SJ, Ferreira CK, van den Brand RJ, Krassioukov AV. Improvements in orthostatic instability with stand locomotor training in individuals with spinal cord injury. Journal of neurotrauma. 2008;25(12):1467-75.
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10. Wolf C, Meiners T. Dysphagia in patients with acute cervical spinal cord injury. Spinal Cord. 2003;41(6):347-53.
11. Chaw E, Shem K, Castillo K, Wong S, Chang J. Dysphagia and associated respiratory considerations in cervical spinal cord injury. Topics in spinal cord injury rehabilitation. 2012;18(4):291-9.
12. Abel R, Ruf S, Spahn B. Cervical spinal cord injury and deglutition disorders. Dysphagia. 2004;19:5-94.
13. Knuijt S, Kalf JG, de Swart BJ, Drost G, Hendricks HT, Geurts AC, et al. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases. Disability and rehabilitation. 2014;36(15):1285-9.
14. Wang BJ, Carter FL, Altman KW. Relationship between dysarthria and oral-oropharyngeal dysphagia: the present evidence. Ear, Nose & Throat Journal. 2020:0145561320951647.
15. Simmons KC, Mayo R. The use of the Mayo Clinic system for differential diagnosis of dysarthria. Journal of communication disorders. 1997;30(2):117-32.
16. Ghoreyshi Z, Nilipour R, Bayat N, Nejad SS, Mehrpour M, Azimi T. The incidence of aphasia, cognitive deficits, apraxia, dysarthria, and dysphagia in acute post stroke Persian speaking adults. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022;74(Suppl 3):5685-95.
17. Stipancic KL, Borders JC, Brates D, Thibeault SL. Prospective investigation of incidence and co-occurrence of dysphagia, dysarthria, and aphasia following ischemic stroke. American Journal of Speech-Language Pathology. 2019;28(1):188-94.
18. Lieuw D, Bipat R, Schraeyen K. First-ever stroke patients in Suriname show more communication disorders than swallowing disorders and these depend on age and length of stay in hospital. ACADEMIC JOURNAL. 2023.
19. Nishio M, Niimi S. Relationship between speech and swallowing disorders in patients with neuromuscular disease. Folia phoniatrica et logopaedica. 2004;56(5):291-304.
20. Otapowicz D, Sobaniec W, Okurowska-Zawada B, Artemowicz B, Sendrowski K, Kułak W, et al. Dysphagia in children with infantile cerebral palsy. Advances in medical sciences. 2010;55(2):222-7.
21. Foroughan M, Jafari Z, Shirin Bayan P, Ghaem Magham Farahani Z, Rahgozar M. Validation of mini-mental state examination (MMSE) in the elderly population of Tehran. Advances in Cognitive Science. 2008;10(2):29-37.
22. Hayashi T, Fujiwara Y, Sakai H, Maeda T, Ueta T, Shiba K. Risk factors for severe dysphagia in acute cervical spinal cord injury. Spinal cord. 2017;55(10):940-3.
23. Hijikata N, Kawakami M, Wada A, Ikezawa M, Kaji K, Chiba Y, et al. Assessment of dysarthria with Frenchay dysarthria assessment (FDA-2) in patients with Duchenne muscular dystrophy. Disability and Rehabilitation. 2022;44(8):1443-50.
24. Bakhtiyari J, Salmani M, Noruzi R, Sarraf P, Barzegar E, Mirmohammadkhani M. Translation, cross-cultural adaptation, validation and reliability of the northwestern dysphagia patient check sheet (NDPCS) in Iran. Iranian Journal of Otorhinolaryngology. 2018;30(97):97.
25. Olivier J, May WL, Bell ML. Relative effect sizes for measures of risk. Communications in statistics-theory and methods. 2017;46(14):6774-81.
26. Wing PC. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care providers. Who should read it? The journal of spinal cord medicine. 2008;31(4):360-.
27. Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Journal of communication disorders. 2013;46(3):238-48.
28. Perez‐Lloret S, Nègre‐Pagès L, Ojero‐Senard A, Damier P, Destée A, Tison F, et al. Oro‐buccal symptoms (dysphagia, dysarthria, and sialorrhea) in patients with Parkinson’s disease: preliminary analysis from the French COPARK cohort. European journal of neurology. 2012;19(1):28-37.
29. Maeshima S, Osawa A, Miyazaki Y, Takeda H, Tanahashi N. Functional outcome in patients with pontine infarction after acute rehabilitation. Neurological Sciences. 2012;33:759-64.
30. Leder SB, Novella S, Patwa H. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyotrophic lateral sclerosis. Dysphagia. 2004;19:177-81.
31. Chen A, Garrett CG. Otolaryngologic presentations of amyotrophic lateral sclerosis. Otolaryngology—Head and Neck Surgery. 2005;132(3):500-4.
32. da Costa Franceschini A, Mourao LF. Dysarthria and dysphagia in amyotrophic lateral sclerosis with spinal onset: a study of quality of life related to swallowing. NeuroRehabilitation. 2015;36(1):127-34.
33. Danesh-Sani SA, Rahimdoost A, Soltani M, Ghiyasi M, Haghdoost N, Sabzali-Zanjankhah S. Clinical assessment of orofacial manifestations in 500 patients with multiple sclerosis. Journal of Oral and Maxillofacial Surgery. 2013;71(2):290-4.
2. Rahimi-Movaghar V, Saadat S, Rasouli MR, Ganji S, Ghahramani M, Zarei M-R, et al. Prevalence of spinal cord injury in Tehran, Iran. The journal of spinal cord medicine. 2009;32(4):428-31.
3. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clinical epidemiology. 2014:309-31.
4. Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. American journal of physical medicine & rehabilitation. 2003;82(10):803-14.
5. Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respiratory care. 2006;51(8):853-70.
6. Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World journal of orthopedics. 2015;6(1):24.
7. Hagen EM, Faerestrand S, Hoff J, Rekand T, Gronning M. Cardiovascular and urological dysfunction in spinal cord injury. Acta neurologica scandinavica. 2011;124:71-8.
8. Harkema SJ, Ferreira CK, van den Brand RJ, Krassioukov AV. Improvements in orthostatic instability with stand locomotor training in individuals with spinal cord injury. Journal of neurotrauma. 2008;25(12):1467-75.
9. Rekand T, Hagen EM, Grønning M. Chronic pain following spinal cord injury. Tidsskrift for Den norske legeforening. 2012.
10. Wolf C, Meiners T. Dysphagia in patients with acute cervical spinal cord injury. Spinal Cord. 2003;41(6):347-53.
11. Chaw E, Shem K, Castillo K, Wong S, Chang J. Dysphagia and associated respiratory considerations in cervical spinal cord injury. Topics in spinal cord injury rehabilitation. 2012;18(4):291-9.
12. Abel R, Ruf S, Spahn B. Cervical spinal cord injury and deglutition disorders. Dysphagia. 2004;19:5-94.
13. Knuijt S, Kalf JG, de Swart BJ, Drost G, Hendricks HT, Geurts AC, et al. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases. Disability and rehabilitation. 2014;36(15):1285-9.
14. Wang BJ, Carter FL, Altman KW. Relationship between dysarthria and oral-oropharyngeal dysphagia: the present evidence. Ear, Nose & Throat Journal. 2020:0145561320951647.
15. Simmons KC, Mayo R. The use of the Mayo Clinic system for differential diagnosis of dysarthria. Journal of communication disorders. 1997;30(2):117-32.
16. Ghoreyshi Z, Nilipour R, Bayat N, Nejad SS, Mehrpour M, Azimi T. The incidence of aphasia, cognitive deficits, apraxia, dysarthria, and dysphagia in acute post stroke Persian speaking adults. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022;74(Suppl 3):5685-95.
17. Stipancic KL, Borders JC, Brates D, Thibeault SL. Prospective investigation of incidence and co-occurrence of dysphagia, dysarthria, and aphasia following ischemic stroke. American Journal of Speech-Language Pathology. 2019;28(1):188-94.
18. Lieuw D, Bipat R, Schraeyen K. First-ever stroke patients in Suriname show more communication disorders than swallowing disorders and these depend on age and length of stay in hospital. ACADEMIC JOURNAL. 2023.
19. Nishio M, Niimi S. Relationship between speech and swallowing disorders in patients with neuromuscular disease. Folia phoniatrica et logopaedica. 2004;56(5):291-304.
20. Otapowicz D, Sobaniec W, Okurowska-Zawada B, Artemowicz B, Sendrowski K, Kułak W, et al. Dysphagia in children with infantile cerebral palsy. Advances in medical sciences. 2010;55(2):222-7.
21. Foroughan M, Jafari Z, Shirin Bayan P, Ghaem Magham Farahani Z, Rahgozar M. Validation of mini-mental state examination (MMSE) in the elderly population of Tehran. Advances in Cognitive Science. 2008;10(2):29-37.
22. Hayashi T, Fujiwara Y, Sakai H, Maeda T, Ueta T, Shiba K. Risk factors for severe dysphagia in acute cervical spinal cord injury. Spinal cord. 2017;55(10):940-3.
23. Hijikata N, Kawakami M, Wada A, Ikezawa M, Kaji K, Chiba Y, et al. Assessment of dysarthria with Frenchay dysarthria assessment (FDA-2) in patients with Duchenne muscular dystrophy. Disability and Rehabilitation. 2022;44(8):1443-50.
24. Bakhtiyari J, Salmani M, Noruzi R, Sarraf P, Barzegar E, Mirmohammadkhani M. Translation, cross-cultural adaptation, validation and reliability of the northwestern dysphagia patient check sheet (NDPCS) in Iran. Iranian Journal of Otorhinolaryngology. 2018;30(97):97.
25. Olivier J, May WL, Bell ML. Relative effect sizes for measures of risk. Communications in statistics-theory and methods. 2017;46(14):6774-81.
26. Wing PC. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care providers. Who should read it? The journal of spinal cord medicine. 2008;31(4):360-.
27. Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Journal of communication disorders. 2013;46(3):238-48.
28. Perez‐Lloret S, Nègre‐Pagès L, Ojero‐Senard A, Damier P, Destée A, Tison F, et al. Oro‐buccal symptoms (dysphagia, dysarthria, and sialorrhea) in patients with Parkinson’s disease: preliminary analysis from the French COPARK cohort. European journal of neurology. 2012;19(1):28-37.
29. Maeshima S, Osawa A, Miyazaki Y, Takeda H, Tanahashi N. Functional outcome in patients with pontine infarction after acute rehabilitation. Neurological Sciences. 2012;33:759-64.
30. Leder SB, Novella S, Patwa H. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyotrophic lateral sclerosis. Dysphagia. 2004;19:177-81.
31. Chen A, Garrett CG. Otolaryngologic presentations of amyotrophic lateral sclerosis. Otolaryngology—Head and Neck Surgery. 2005;132(3):500-4.
32. da Costa Franceschini A, Mourao LF. Dysarthria and dysphagia in amyotrophic lateral sclerosis with spinal onset: a study of quality of life related to swallowing. NeuroRehabilitation. 2015;36(1):127-34.
33. Danesh-Sani SA, Rahimdoost A, Soltani M, Ghiyasi M, Haghdoost N, Sabzali-Zanjankhah S. Clinical assessment of orofacial manifestations in 500 patients with multiple sclerosis. Journal of Oral and Maxillofacial Surgery. 2013;71(2):290-4.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Traumatic spinal cord injury, Dysarthria, Dysphagia, Comorbidity, Rehabilitation | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sheykh chalandari S, Farazi M, Sadeghi Z, Norouzi M. Dysarthria and Dysphagia in Traumatic Spinal Cord Injury: Frequency and Comorbidity in a Cross-Sectional Study. jmr. 2025;(-).
