Assessment and Management of Dysphagia in Acute Stroke: An Initial Service Review of International Practice.

Carol A Fairfield,David G Smithard

doi:10.3390/geriatrics5010004

Abstract

The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management tended to be similar within, but not between, countries. Relationships were found between the use of instrumental assessment and the compensatory management techniques that were employed. The variation in practice that was found, may reflect the lack of an available robust evidence base to develop care pathways and identify the best practice. Further investigation and identification of the impact on dysphagia outcome is needed.

Highlights

Dysphagia, which may be defined as difficulty in any part of the swallowing function orthe ingestion of food or liquid from the oral cavity to the stomach, is common in those people admitted with a stroke, with somewhere between 28% and 70% of people having difficulty with their swallow
This study has provided novel initial data on the assessment and management practices, and the potential relationships therein, within the international arena and in the acute phase post stroke
A clinical bedside assessment was not explored in this initial review, as it was identified as a requisite within professional guidelines in the countries in this review

Summary

Introduction

Dysphagia, which may be defined as difficulty in any part of the swallowing function orthe ingestion of food or liquid from the oral cavity to the stomach, is common in those people admitted with a stroke, with somewhere between 28% and 70% of people having difficulty with their swallow.The greater proportion of people will recover their swallow quickly, but dysphagia persists in 11–50% of patients post stroke at six months [1,2,3]. Dysphagia, which may be defined as difficulty in any part of the swallowing function orthe ingestion of food or liquid from the oral cavity to the stomach, is common in those people admitted with a stroke, with somewhere between 28% and 70% of people having difficulty with their swallow. Stroke may lead to mild, moderate, or severe swallowing difficulties, ranging from difficulty with hard or mixed texture foods, to potentially requiring alternative means of nutritional intake in order to reduce the risk of aspiration, malnutrition, or dehydration, or to reduce the risk of mortality [3,4]. Dysphagia may present as difficulty in the initiation of the reflex stage of the swallow following an infarction in the brainstem, bilateral strokes, difficulty in motor programming, as seen in swallowing dyspraxia [5], or as a result of severe unilateral hypotonic muscles of the lips and tongue affecting bolus transfer within the oral cavity. There is a large economic cost [1], in addition to the impact on the quality of life for an individual [6]

Methods

Results

Discussion

Conclusion