OBJECTIVE To identify and characterize subgroups of stroke patients with clinical signs of dysphagia, based on swallowing-related strength and skill impairments of the submental muscle group. DESIGN Prospective observational study. SETTING Inpatient rehabilitation centers and community dwellings. PARTICIPANTS Stroke patients with dysphagia (n=55), and two control groups: myopathic patients with dysphagia (n=19) and healthy volunteers (n=40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Novel clinical assessment of strength (force generation) and skill (spatial and temporal precision of muscle activation) of the submental muscle group during swallowing and non-swallowing behaviours, using surface electromyography and dynamometry. RESULTS Hierarchical cluster analysis revealed four clusters which could be broadly characterized as: Cluster 1 - intact strength and skill, Cluster 2 - poor strength and poor non-swallowing skill, Cluster 3 - poor strength, and Cluster 4 - poor strength and poor swallowing skill. Membership in cluster was significantly associated with medical diagnosis (p < .001). The majority of healthy and myopathic participants were assigned to Clusters 1 and 3 respectively, while stroke patients were found in all four clusters. Skill outcome measures were more predictive of cluster assignment than strength measures. CONCLUSIONS While healthy and myopathic participants demonstrated predominantly homogeneous swallowing patterns of submental muscle function within their etiology, several subgroups were identified within stroke, possibly reflecting different subtypes of swallowing function. Future research should focus on the nature and rehabilitation needs of these subtypes. Assessment of skill in swallowing may be an important but overlooked aspect of rehabilitation.

中文翻译：

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基于颏下肌力和技能损伤模式的脑卒中吞咽困难患者的亚组分类

目的：基于颏下肌群的吞咽相关力量和技能损伤，识别和表征具有吞咽困难临床体征的卒中患者亚组。设计前瞻性观察研究。设置 住院康复中心和社区住宅。参与者 有吞咽困难的中风患者 (n=55) 和两个对照组：有吞咽困难的肌病患者 (n=19) 和健康志愿者 (n=40)。干预 不适用。主要结果测量 使用表面肌电图和测力计对吞咽和非吞咽行为期间颏下肌群的力量（力的产生）和技能（肌肉激活的空间和时间精度）进行新的临床评估。结果 分层聚类分析揭示了四个聚类，其大致特征如下：第 1 组 - 完整的力量和技能，第 2 组 - 力量和非吞咽技能差，第 3 组 - 力量差，以及第 4 组 - 力量和吞咽技能差。集群成员与医疗诊断显着相关（p < .001）。大多数健康和肌病参与者分别被分配到第 1 组和第 3 组，而在所有四个组中都发现了中风患者。技能结果测量比强度测量更能预测集群分配。结论 虽然健康和肌病参与者在其病因中表现出主要是颏下肌肉功能的均匀吞咽模式，但在中风中确定了几个亚组，可能反映了吞咽功能的不同亚型。未来的研究应侧重于这些亚型的性质和康复需求。吞咽技能的评估可能是康复的一个重要但被忽视的方面。