Management of neurological dysphagia

Park, C.; O'Neill, PA

doi:10.1177/026921559400800210

Cited by 10 publications

(8 citation statements)

References 58 publications

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“…Other patients apparently develop new problems. We need to examine the best management of dysphagia, not only in the acute phase but also for those with ongoing difficulties [18]. …”

Section: Discussionmentioning

confidence: 99%

The Natural History of Dysphagia following a Stroke

Smithard

O’Neill

England³

et al. 1997

Dysphagia

461

290

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To assess the frequency and natural history of swallowing problems following an acute stroke, 121 consecutive patients admitted within 24 hours of the onset of their stroke were studied prospectively. The ability to swallow was assessed repeatedly by a physician, a speech and language therapist, and by videofluoroscopy. Clinically 51% (61/121) of patients were assessed as being at risk of aspiration on admission. Many swallowing problems resolved over the first 7 days, through 28/110 (27%) were still considered at risk by the physician. Over a 6-month period, most problems had resolved, but some patients had persistent difficulties (6, 8%), and a few (2, 3% at 6 months) had developed swallowing problems. Ninety-five patients underwent videofluoroscopic examination within a median time of 2 days; 21 (22%) were aspirating. At 1 month a repeat examination showed that 12 (15%) were aspirating. Only 4 of these were persistent; the remaining 8 had not been previously identified. This study has confirmed that swallowing problems following acute stroke are common, and it has been documented that the dysphagia may persist, recur in some patients, or develop in others later in the history of their stroke.

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“…Other patients apparently develop new problems. We need to examine the best management of dysphagia, not only in the acute phase but also for those with ongoing difficulties [18]. …”

Section: Discussionmentioning

confidence: 99%

The Natural History of Dysphagia following a Stroke

Smithard

O’Neill

England³

et al. 1997

Dysphagia

461

290

View full text Add to dashboard Cite

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“…Bronchopneumonia is a common cause of death and morbidity in late MS; a possible contributing factor may be dysphagia leading to aspiration and a resultant pneumonia. Emaciated MS patients are sometimes encountered in whom the cause of weight loss seems unclear; dysphagia leading to an inability to maintain adequate nutrition may be one possible cause [4]. Potential mechanisms of abnormal Abstract In this observational study of patients with multiple sclerosis (MS) admitted to a regional neurology centre we assessed the frequency of dysphagia (objectively defined), dysphagia related symptoms, bulbar signs and nutritional status.…”

mentioning

confidence: 99%

Dysphagia and nutritional status in multiple sclerosis

THOMAS

Wiles

1999

Journal of Neurology

105

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In this observational study of patients with multiple sclerosis (MS) admitted to a regional neurology centre we assessed the frequency of dysphagia (objectively defined), dysphagia related symptoms, bulbar signs and nutritional status. We studied 79 consecutive admissions with MS (24 at diagnostic admission and 55 more advanced cases admitted for treatment and/or rehabilitation): normative swallowing data were from 181 healthy controls. Swallowing symptoms and signs were semi-quantitatively measured and compared to healthy controls. Dysphagia was defined by a quantitative water test. Disability was determined by Kurtzke's Expanded Disability Status Scale and Barthel's index. Nutritional status was assessed by body mass index, estimated percentage body fat from skin fold thickness measurements at four sites, a global evaluation of nutrition, the presence of pressure sores and the pressure sore risk using the Waterlow score. Patients with MS were more likely to complain of abnormal swallowing, of coughing when eating, and of food 'going down the wrong way' than healthy controls (P < 0.005). These significantly associated symptoms had high specificity but relatively low sensitivity. 43% of patients had abnormal swallowing, almost half of whom did not complain of it: abnormal swallowing was associated with several factors including abnormal brainstem/cerebellar function, disability, vital capacity, and depression score. Those with abnormal swallowing had higher Waterlow scores (P < 0.001), but, overall, abnormal swallowing was not associated with a difference in nutritional indices or incidence of pressure sores. In summary, abnormal swallowing is common in MS although often not complained of. It is associated with disordered brainstem/cerebellar function, overall disability, depressed mood and low vital capacity. It was not associated with major nutritional failure or pressure sores in this study.

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“…It is recognised that the management of patients with severe dysphagia is contentious and the subject of on-going multi-centre randomised controlled trials. Nasogastric (NG) or PEG feeding may not be appropriate when a patient is in the terminal phase of the disease (Park and O'Neill 1994).…”

Section: Discussionmentioning

confidence: 99%

Variation in the Management of Dysphagia after Stroke: Does SLT make a Difference?

Lucas

Rodgers

1998

Int J Lang Commun Disord

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Dysphagia is a frequent consequence of acute stroke. Previous studies have demonstrated better clinical outcomes for patients managed by dysphagia teams, which have always included a speech and language therapist (SLT). This study compares dysphagia management for stroke patients in two hospitals with differing involvement of SLTs in dysphagia services. There was a trend towards better identification of dysphagia, more complete documentation of nutrition and hydration management, less risky dysphagia management and less perceived need for chest physiotherapy at the hospital with locally-based SLT provision, compared with the hospital with extra-contractual referral (ECR) for SLT dysphagia assessment. The specific contribution of the SLT in the dysphagia team is discussed.

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Management of neurological dysphagia

Cited by 10 publications

References 58 publications

The Natural History of Dysphagia following a Stroke

The Natural History of Dysphagia following a Stroke

Dysphagia and nutritional status in multiple sclerosis

Variation in the Management of Dysphagia after Stroke: Does SLT make a Difference?

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