Predictors of Oral Feeding Resumption after Stroke in a Rehabilitation Hospital: A Retrospective Study

Calvo, Irene; Pizzorni, Nicole; Gilardone, Giulia; Mayer, Flávia; Vanacore, Nicola; Buraschi, Valentina; Gilardone, Marco; Corbo, Massimo

doi:10.1016/j.jstrokecerebrovasdis.2019.03.040

Cited by 27 publications

(52 citation statements)

References 38 publications

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“…This is in line with the results of other FEES studies, which also report premature bolus spillage as the leading finding in patients with acute stroke. [24][25][26][27][28] However, the phenotype also occurred in almost all other disease groups, albeit in much smaller numbers. Premature bolus spillage can lead to predeglutitive aspiration, as the airway is not protected before the initiation of swallowing.…”

Section: Discussionmentioning

confidence: 97%

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Neurogenic Dysphagia

et al. 2021

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Objective:Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).Methods:A systematic literature review was conducted, searching MEDLINE from inception to 05/2020 for FEES findings in neurological diseases of interest. Based on a retrospective analysis of FEES-videos in neurological diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1012 randomly selected FEES-videos of patients with various neurological disorders. Chi-square-tests were used to compare the distribution of dysphagia phenotypes between the underlying neurological disorders.Results:159 articles were identified of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) “Premature bolus spillage” and (2) “delayed swallowing reflex” occurred mainly in stroke patients, (3) “predominance of residue in the valleculae” was most common in Parkinson's disease, (4) “predominance of residue in the piriform sinus” occurred only in myositis, motoneuron disease and brainstem stroke patients, (5) “pharyngolaryngeal movement disorder” was found in atypical Parkinsonian syndromes and stroke patients, (6) “fatigable swallowing weakness” was common in patients with myasthenia gravis, and (7) “complex disorder” with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic later sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).Conclusion:Neurogenic dysphagia is not a mere symptom, but a multi-etiological syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.

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Section: Discussionmentioning

confidence: 97%

“…In cases of expected counts <5, the Fisher exact test was used. As 112 25-28,e14,e15 often reported as main finding [25][26][27][28] Pharyngeal residue 25-28,e14,e16-e19 with reduced response to residue e20…”

Section: Discussionmentioning

confidence: 97%

Neurogenic Dysphagia

et al. 2021

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“…The indwelling nasogastric tube can easily make the esophageal sphincter lose its integrity, increase the pharyngeal reflex threshold and reflux the contents of the gastroesophagus, thereby increasing the risk of aspiration (44). Studies (45,46) have shown that aspiration related pneumonia in stroke patients with dysphagia is mainly caused by aspiration, and aspiration pneumonia is closely associated with the death of stroke patients. The gastric tube is inserted intermittently to avoid long-term indwelling of the gastric tube, which can reduce the secretion of gastric acid and reflux of gastric contents, and prevent the bacteria in the stomach from migrating to the throat and inhaling the lower respiratory tract, thereby reducing the occurrence of aspiration pneumonia There are certain limitations in this study that should be concerned.…”

Section: Discussionmentioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.Methods: Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.Results: A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function

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“…Recent work in stroke has attempted to predict the influence of post-stroke dysphagia and other patient factors on unfavorable outcomes. There is an association of post-stroke dysphagia with increased mortality [ 22 , 28 , 30 , 34 , 37 , 56 – 58 ], overall unfavorable outcome [ 34 , 35 , 58 ], greater dependency [ 30 , 36 , 57 ], longer length of stay [ 33 , 36 ], less likely to discharge home [ 35 , 36 , 57 , 58 ], and modified diet or reliance on tube feeding [ 22 , 35 , 43 , 57 ]. Longer length of stay due to dysphagia may occur in patients whose medical evaluation is completed, but the medical team is waiting to see if the dysphagia will resolve or a percutaneous gastrostomy tube is needed, as many skilled nursing facilities will not admit patients reliant to tube feeding, but without a permanent feeding tube.…”

Section: What Are the Consequences Of Post-stroke Dysphagia?mentioning

confidence: 99%

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Jones¹,

Colletti

Ding

2020

Curr Neurol Neurosci Rep

100

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Purpose of Review We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? Recent Findings There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Summary Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.

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Predictors of Oral Feeding Resumption after Stroke in a Rehabilitation Hospital: A Retrospective Study

Cited by 27 publications

References 38 publications

Neurogenic Dysphagia

Neurogenic Dysphagia

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

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