Dysphagia after stroke and its management

Martino, Rosemary; Martin, Ruth Elwood; Black, Sandra E.

doi:10.1503/cmaj.101659

Cited by 39 publications

(29 citation statements)

References 16 publications

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“…For those 2 groups of patients, an apparent dysphagia clinical assessment was used instead to determine the frequency of dysphagia. However, the rate of dysphagia screening in our population is higher than that reported in other investigations reporting that only 50% of stroke patients are being screened for dysphagia [24] . The occurrence of dysphagia in our study was associated with speech dysfunction and the conscious disturbance of patients.…”

Section: Discussioncontrasting

confidence: 73%

Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Al‐Khaled¹,

Matthis

Binder

et al. 2016

Cerebrovasc Dis

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Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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Section: Discussioncontrasting

confidence: 73%

Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Al‐Khaled¹,

Matthis

Binder

et al. 2016

Cerebrovasc Dis

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“…It is a symptom which indicates a delay in the passage of solids or liquids from the oral cavity to the stomach [1,2]. Dysphagia is a serious consequence of stroke [3], because of the risk of aspiration, malnutrition, dehydration, long-term hospitalization, airway obstruction, and ultimately death [4]. Dysphagia and related complications are associated with increased mortality, comorbidity and increased health care costs [5].…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal Dysphagia in Acute Stroke Patients

Asadollahpour

Baghban

Asadi

et al. 2015

Zahedan J Res Med Sci

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Background:The objective of this study was to investigate the prevalence of different kinds of swallowing disorder and it's severity in patients after stroke. Patients and Methods: In this cross sectional study, 91 consecutive stroke patients were screened by the Northwestern Dysphagia Patient Check Sheet (NDPCS) and the Gugging Swallowing Screen (GUSS). Results: Forty seven percent of those assessed demonstrated signs of oropharyngeal dysphagia. Mild dysphagia was seen in (10.98%) patients, moderate dysphagia was present in 14.28% and 22% patients had severe dysphagia. Conclusions: Dysphagia is common after acute stroke and its presence can have serious consequences. These results emphasize the importance of assessment and management of swallowing function in stroke patients.

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“…The ability to swallow food and liquid is something that most people take for granted; however, studies show that approximately half of stroke survivors experience dysphagia (swallowing impairment)[1, 2]. Dysphagia involves two primary concerns: a) the ability to swallow safely , without aspirating material into the respiratory system; and b) the ability to swallow efficiently , without leaving residual material behind in the pockets of the pharynx (i.e., the valleculae and pyriform sinuses) [3].…”

mentioning

confidence: 99%

A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia

et al. 2016

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The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol (“Tongue-Pressure Profile Training”) emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol (“Tongue-Pressure Strength and Accuracy Training”) emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage Transition Duration (a measure of the duration of bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the Penetration-Aspiration Scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength, however tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

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Dysphagia after stroke and its management

Cited by 39 publications

References 16 publications

Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Oropharyngeal Dysphagia in Acute Stroke Patients

A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia

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