Interdisciplinary management of dysphagia following stroke

Abstract

Dysphagia (difficulty swallowing) is common following stroke. It significantly affects quality of life and places patients at risk of pneumonia, malnutrition and death. An interdisciplinary approach is necessary to ensure patients with dysphagia remain safe. This paper provides a review of current practice in the UK and current evidence in the management of dysphagia following stroke. The roles of the dietitian, nurse, pharmacist and speech and language therapist in dysphagia management are discussed. The article focuses on the acute phase of stroke management and short-term management of swallow safety as well as nutrition, hydration and pharmaceutical needs.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study

“…With pharmacists performing dysphagia screening in the community setting, this could open a referral pathway to the speech pathologist for thorough assessment and advice; and would allow pharmacists to identify and prevent potentially serious medication misadventure. 9 , 10 The value of having pharmacist input to assess patients who are taking medications which increase falls risk, was highlighted by an occupational therapist to tailor their implementation of home safety measures. This would be significant because there are many medications which increase drowsiness, dizziness, decrease bone mineral density and overall falls risk, especially in elderly patients.…”

“… 9 Limited availability of varied dosage forms creates challenges when it comes to clinical decision making, therefore it has been suggested that collaboration between these two disciplines may target early intervention strategies to optimize medication management and prevent worsening conditions. 10 Occupational therapists’ collaboration with pharmacists has the potential to improve home-health care services, evaluate patient medication-related skills and identify risks of non-adherence. 11 This collaboration will allow recommendations for supportive aids to reduce medication misadventure, implementation of health literacy interventions, and additional support for palliative care services.…”

“…Studies have also been undertaken to assess poor workforce distribution in rural Australia and the benefits of interdisciplinary collaboration. 1–3 , 6 , 10 However, this study has focused specifically on primary care dieticians’, speech pathologists’, occupational therapists’, and physiotherapists’ potential for collaboration with pharmacists in rural communities and aims to identify whether pharmacists can be utilised within a collaborative care model.…”

A randomized controlled study investigating the efficacy of electro-acupuncture and exercise-based swallowing rehabilitation for post-stroke dysphagia: Impacts on brainstem auditory evoked potentials and cerebral blood flow

“…[ 1 ] Post-stroke dysphagia (PSD), with 2024 ICD-10-CM Diagnosis Code I69.391 (dysphagia following cerebral infarction), is related to the decline of oral, pharyngeal, and esophageal functioning, in addition to other serious problems, such as airway obstruction, aspiration, aspiration pneumonia, dehydration, malnutrition, sepsis, and death; it can also lead to social isolation, affect the patient quality of life, and may lead to the delay of rehabilitation and increase the economic burden. [ 2 ] Therefore, it is very important to effectively accelerate the recovery of swallowing function to reduce these risks.…”

The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study

“…Dysphagia is a common complication following stroke with reported incidences around 20%-78% however varying greatly in the literature, depending on assessment process (Arnold et al, 2016;Flowers, Silver, Fang, Rochon, & Martino, 2013;Martino, Martin, & Black, 2012, Martino et al, 2005National Stroke Foundation., 2010). The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and providing feedback regarding current status to other team members (McFarlane et al, 2014, Hines et al, 2011, Bird, 2001, Cichero et al, 2009, Daniels et al, 2012, Kertscher et al, 2014, Smithard, 2016, Speyer, 2013, Trapl et al, 2007. Despite the efforts of the multidisciplinary team, dysphagia following stroke is often associated with a number of clinical complications including aspiration pneumonia, dehydration, malnutrition and subsequently the need for non-oral feeding (Arnold et al, 2016;Dziewas et al, 2004;Foley, Martin, Salter, & Teasell, 2009).…”