Introduction
Rippling tongue movement is one of swallowing hesitation and is defined that the movement of tongue is visible but the oral to pharyngeal transit does not progress. It is known to be associated with apraxia, and be caused by left primary motor cortex lesion which include left precentral gyrus.
Clinically, rippling tongue movement is suggested to influence the swallowing function in stroke patients, however, dysphagia symptoms of oral phase including rippling tongue movement is neglected in clinical analysis. In addition, there has been no researches on the relationship among rippling tongue movement, characteristic of dysphagia, and aspiration.
Therefore, we retrospectively collected the cases with rippling tongue movements from the patients with frontal lobe stroke and preliminarily analyzed rippling tongue movement and the characteristics of dysphagia
Method
Twenty patients were recruited by reviewing the electric medical records. Patients visited our hospital from January 2017 to June 2019 for rehabilitation treatment of dysphagia after frontal lobe stroke. Attending physicians physically examined each patient’s swallowing function and evaluated it using clinical dysphagia scale (CDS) and videofluoroscopic swallowing study (VFSS). All patients were divided into 2 groups, rippling group and non-rippling group. The rippling group consisted of people with repetitive rippling tongue movement in the oral phase. Linear-by-linear association and chi-squared test were used to analyze the association between each group and variables of VFSS.
Results:
Nine out of 20 patients showed rippling type tongue movement. In rippling group, 2 were male and 7 were female. The average age was 73.6 and the average CDS score was 41.9. Three out of 9 strokes were caused by infarction, and 6 were caused by hemorrhage. Four out of 9 in rippling group had lesions in the left brain. Two out of 9 had lesions in the right brain. Three out of 9 had no left-right mention of brain lesions. Among 11 patients in the non-rippling group, 3 were male and 8 were female. The average age was 62.5 and the average CDS score was 19.5. One of 11 strokes were caused by infarction and 10 were caused by hemorrhage.
Patients with rippling tongue movement tended to have an increased CDS score.
Discussion
This is the first analysis on the relationship between rippling tongue movement and characteristics of dysphagia in the frontal lobe stroke. Rippling tongue movement group showed higher CDS score than non-rippling group and may imply that rippling tongue movement be associated with the possibility of aspiration and the severity of dysphagia. The present study implies that the clinicians should evaluate and interpret them to reveal a type of dysphagia and set proper treatment plan in clinical setting.
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