Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

D'Netto, Pamela; Rumbach, Anna F.; Dunn, Katrina; Finch, Emma

doi:10.1007/s00455-022-10443-3

Cited by 37 publications

(26 citation statements)

References 47 publications

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Section: Discussionmentioning

confidence: 99%

“…Dysphagia is a stroke complication with heavy prognostic implications [1][2][3]. Its presence at admission and persistence are independent predictors of poor outcome, favoring the onset of dysphagia-related complications, like aspiration pneumonia and malnutrition [1][2][3]. Hence, early detection and management of dysphagia leads to fewer complications, a shorter hospitalization and ultimately a better prognosis [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of dysphagia in patients with ischaemic stroke is highly variable, depending on assessment methods and ranging from 8% to 80% [1][2][3]. The frequency is higher (between 64% and 80%) when instrumental tools (videofluoroscopy or fiberoptic endoscopic evaluation of swallowing [FEES]) are used [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Early predictors of dysphagia in ischaemic stroke patients

Mattavelli

Mele

Cova

et al. 2023

Euro J of Neurology

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Background and purpose Post‐stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia. Methods Ischaemic stroke patients underwent clinical, cognitive and pre‐morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale. Results In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05), pre‐event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09–1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49–2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82–19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05–2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85–0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre‐event mRS (OR 1.28, 95% CI 1.04–1.56), admission NIHSS (OR 1.88, 95% CI 1.56–2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44–32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95–7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83–0.96) and thrombolysis (OR 0.77, 95% CI 0.23–0.95) had a protective role. The 6‐point “NOTTEM” (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk. Conclusions Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Early predictors of dysphagia in ischaemic stroke patients

Mattavelli

Mele

Cova

et al. 2023

Euro J of Neurology

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“…While early accurate identification and characterization of dysphagia in ischaemic stroke patients with large vessel occlusion is of paramount importance to guide management, it may also provide prognostic information concerning medium‐term outcome 11,12 and quality of life. It is well known that the severity of dysphagia is associated with decreased health‐related quality of life (HRQoL) independently of the aetiology of dysphagia 13 .…”

Section: Introductionmentioning

confidence: 99%

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

Pinho,

Meyer,

Mall

et al. 2024

Ann Clin Transl Neurol

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ObjectiveThe aims of the study were to (1) characterize the findings of flexible endoscopic evaluation of swallowing (FEES) in stroke patients undergoing mechanical thrombectomy (MT); (2) analyse the screening performance of the Standardized Swallowing Assessment (SSA); and (3) study the impact of FEES‐defined dysphagia on 3‐month outcomes.MethodsThis single‐centre study was based on a local registry of consecutive acute ischaemic stroke patients undergoing MT during a 1‐year period. Patients received FEES within 5 days of admission regardless of the result of dysphagia screening. We compared baseline demographic and clinical characteristics of patients with and without FEES‐defined dysphagia. We collected 3‐month modified Rankin Scale (mRS) and individual index values of the European Quality of Life 5 Dimensions (EQ‐5D‐iv). Using univariable and multivariable regression analyses we predicted 3‐month outcomes for presence of dysphagia and for FEES‐defined dysphagia severity.ResultsWe included 137 patients with a median age of 74 years, 43.1% were female, median NIHSS was 12 and successful recanalization was achieved in 92.7%. Stroke‐associated pneumonia occurred in 8% of patients. FEES‐defined dysphagia occurred in 81% of patients. Sensitivity of the SSA as a dysphagia screening was 67%. Presence of dysphagia and increasing severity of dysphagia were independently associated with increasing 3‐month mRS score. Increasing dysphagia severity dysphagia was independently associated with lower EQ‐5D‐iv.InterpretationEarly FEES‐defined dysphagia occurs in four in every five patients undergoing MT. SSA has a suboptimal dysphagia screening performance. Presence of dysphagia and increasing dysphagia severity predict worse functional outcome and worse health‐related quality‐of‐life.

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“…Dysphagia is a common complication after stroke, with an incidence ranging from 8.1 to 45% [1]. It can lead to many problems, such as malnutrition, pneumonia, airway obstruction, or even death [2,3].…”

Section: Introductionmentioning

confidence: 99%

The effect of real versus sham intermittent theta burst transcranial magnetic stimulation combined with conventional treatment on poststroke dysphagia: a randomized controlled trial

Suh,

You,

Son

et al. 2024

International Journal of Rehabilitation Research

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Repetitive transcranial magnetic stimulation to the pharyngeal motor cortex has shown beneficial effects on poststroke dysphagia. Previous studies, however, using intermittent theta burst stimulation (iTBS) for dysphagia have targeted the suprahyoid motor cortex. This study aimed to investigate the effects of iTBS to the pharyngeal motor cortex in patients with poststroke dysphagia, using ultrasound and videofluoroscopic swallowing studies (VFSS). A randomized controlled trial was conducted on patients with dysphagia due to a first-time unilateral stroke. Patients who had signs and symptoms of dysphagia and showed aspiration or penetration on VFSS were included. Twenty-eight patients were randomly assigned to either real or sham iTBS groups, and each patient underwent five sessions of iTBS to the ipsilesional pharyngeal motor cortex. Each iTBS session was followed by conventional dysphagia treatment for 30 min. The hyoid–larynx approximation measured by ultrasound, penetration–aspiration scale (PAS) and functional dysphagia scale (FDS) assessed by VFSS were evaluated before and after completion of iTBS. There were no significant differences between the two groups in terms of demographic and clinical characteristics, including age and type of stroke. The hyoid–larynx approximation ratio increased in the real iTBS group and decreased in the sham iTBS group (median values of pre–post differences were 0.27 vs. −0.01, P < 0.001). The PAS and FDS showed greater improvements in the real iTBS group than in the sham iTBS group (median values of pre–post differences of the PAS were −2.50 vs. 0.00, P = 0.004; median values of pre–post differences of the FDS were −12.50 vs. −2.50, P < 0.001). No adverse effects were reported during or after iTBS sessions. Five-session iTBS to the pharyngeal motor cortex combined with conventional treatment led to a significant improvement in poststroke dysphagia in terms of hyoid–larynx approximation which is related to the suprahyoid muscle. Considering the short duration of one iTBS session, this can be an efficient and effective treatment tool for patients with this condition.

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Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

Cited by 37 publications

References 47 publications

Early predictors of dysphagia in ischaemic stroke patients

Early predictors of dysphagia in ischaemic stroke patients

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

The effect of real versus sham intermittent theta burst transcranial magnetic stimulation combined with conventional treatment on poststroke dysphagia: a randomized controlled trial

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