Neurogene Dysphagie im Rahmen der Neurologischen Komplexbehandlung und strukturelle Komponenten eines Dysphagieprogrammes

Abstract

▼ Introduction: An important aim of the Stroke Unit concept is the standardisation of diagnostics in stroke patients in order to help the nursing staff , swallowing therapists, dieticians and doctors for an early identifi cation of neurogenic oropharyngeal dysphagia (NOD). This enables the team to initiate appropriate therapeutic measures and to avoid complications such as aspiration pneumonia and malnutrition. Methods: With regard to the clinical assessment of swallowing by nursing staff and swallowing therapists a standardized swallowing assessment for dsyphagic patients and a standardized clinical swallowing examination (CSE) according to validated criteria is recommended. The clinical assessments should be followed by specifi c technical examinations like the swallowing endoscopy and/or videofl uoroscopy. Results: Studies with severe dysphagic stroke patients show that age, neuroanatomical lesions and scoring parameters (clinical assessment and technical examination) are important to predict the outcome of patients. With regards to the grading of dysphagic stroke patients the functional communication measure swallowing (FCM) as well as the penetration-aspiration-scale (PAS) show in a multivariate analysis an AUC of 73 % for the endpoint "tube-feeding at the end of neurorehabilitation (FCM 1-3 at day 90)". In a longitudinal study for the implementation of a dyphagia programm in a certifi ed stroke unit a reduced rate of pneumonia and in-hospital-mortality could be seen. Discussion: Establishing the degree of penetration and aspiration, as well as further symptoms such as leaking and retention is one of the essential criteria in the assessment of dysphagia with subsequent pathophysiologically-orientated procedures for the functional treatment of the swallowing disorder. This also includes the diagnostic procedures necessary to decide upon invasive