Avoiding the Downward Spiral After Stroke: Early Identification and Treatment of Dysphagia

Abstract

This paper reviews recent evidence concerning the epidemiology, evaluation, and treatment of post-stroke dysphagia. The large variability in dysphagia severity and outcomes after stroke warrant a comprehensive evaluation and treatment approach. Screening, bedside evaluation, and instrumental assessments should be systematically and consistently used based on clinical presentation and available resources. In addition to traditional methods of diet modification and implementation of strategies and exercises, the use of novel treatments such as biofeedback and noninvasive brain stimulation may be effective in treatment, though further research is warranted. Oral hygiene regimens may be instrumental in reducing the incidence of swallowing-related respiratory compromise in patients with dysphagia. Dysphagia after stroke is optimally assessed by timely and appropriately selected screening and evaluation. Treatment depends on pathophysiology, with more research needed to assess the effectiveness of interventions as a part of an individualized treatment plan.