Findings in orofacial praxis in clinical swallow examination in patients with neurogenic oropharyngeal dysphagia

Abstract

Introduction

Praxis facilitate the execution of learned motor acts, including swallowing. Inability to perform praxis movements, or apraxia, may be classified according to different criteria. Buccopharyngeal apraxia includes orofacial apraxia. Clinical swallow evaluation does not typically include assessment of oropharyngeal/orofacial praxes; however, this would be of great semiological value, particularly in patients with neurological and neuromuscular disorders who present with dysphagia. The objective of this study was to explore and compare findings from the assessment of 3 orofacial praxis in healthy individuals without dysphagia and in patients with neurogenic oropharyngeal dysphagia, as part of the clinical swallow examination.

Methods

We designed a case–control study based on a clinical swallow examination that included an assessment of 3 orofacial praxis. Comparisons were made, and odds ratios with 95% confidence intervals were calculated. Non-performance of the 3 orofacial praxis was recorded separately and jointly, adjusting for sex and age in both groups, as well as for other clinical variables of interest in the patient group.

Results

Our study included 86 patients and 80 controls. Oral motor apraxia was associated with oropharyngeal dysphagia; more specifically, the presence of neurogenic oropharyngeal dysphagia was found to be associated with difficulty in moving both lips together to either side, as well as with such other physical examination findings as tongue fasciculations and atrophy, and impaired tongue coordination. No statistically significant association was observed with age or sex in either group.

Conclusion

Assessment of orofacial praxes can help to identify patients with neurogenic oropharyngeal dysphagia.