Efficacy and needs of secondary dysphagia screening in post-acute care for change in diet program in patients after acquired brain injuries

Abstract

Recent studies have shown the incidence of dysphagia in patients after traumatic brain injury up to 50% and in stroke patients between 35–40%. This paper presents the effectiveness and needs of secondary dysphagia screening in post-acute care with consequent influence on the change in diet program. Current situation shown that not all patients with presence of dysphagia are adequately screened in acute hospital settings with concurrent safety and quality of life's compromise. We have placed issue whether secondary dysphagia screening will help identify another dysphagia patients in post-acute care (rehab setting) and thus to improve patients safety and quality of life. Patients with diagnosis acquired brain injury in subacute phase, who were hospitalized in Kladruby Rehabilitation Centre with primary dysphagia screening, were included. One hundred and twenty-four patients were secondary GUSS screened and different types of dysphagia were diagnosed in 27 of them. Dysphagic patients were divided into 4 groups according to the dysphagic diet levels. Twenty-six patients had specific speech therapist's intervention and electrostimulation therapy was applied in 13 of them. Out of 26 patients, 73.1% were improved. Among the patients, 57.7% were improved in one diet category, 2 patients changed from PEG to non-dysphagic diet program and one patient changed form PEG to advanced level. From all of 26 dysphagia patients were 61.5% with out dysphagic diet program. The effectiveness of secondary screening in 124 patients, when 27 dysphagic patients were determined, supported a need of secondary screening in post-acute care (rehab setting) and led to set appropriate speech intervention using electrostimulation of the pharyngeal muscles and in 73.1% dysphagic patients the diet category was changed. The application of electrostimulation to the pharyngeal muscles under the leading of the speech therapist shows one of the very good ways how to improve quality of life in patients with acquired brain injury.