Cause Of Aspiration Pneumonia Research Articles

Impacts of body positions on the geniohyoid muscle contraction and swallowing difficulty in healthy adults.

Body positions affect swallowing and gastroesophageal reflux. Swallowing impairment is one of the main causes of aspiration pneumonia. To prevent pneumonia, evaluation of body positions on gastroesophageal reflux recommended 30 degrees or higher semi-recumbent positions. The geniohypoid muscle and tongue play central roles in swallowing. However, the effects of body positions on contracting rates in the geniohyoid muscle and tongue pressure are unclear. Moreover, correlations between geniohyoid muscle contracting rates and subjective swallowing difficulties are unclear. This study aimed to identify the proper body positions on contracting rates in the geniohyoid muscle, tongue pressure, and subjective swallowing difficulties. Twenty healthy adults swallowed 15- or 50 ml of water at 90 degrees sitting, 60- and 30 degrees semi-recumbent, and 0 degrees supine positions. We scored the subjective swallowing difficulties and measured the tongue pressure and the number of swallows. An ultrasound evaluated the geniohyoid muscle size and contracting rates. At sitting and 60 degrees semi-recumbent positions, the geniohyoid muscle showed greter contracting rates than at 30 degrees semi-recumbent and supine postions (P < 0.05), which resulted in easier swalloiwng. Greater tongue pressure was weakly correlated with fewer swallows (r = -0.339, P = 0.002), whereas the body positions did not affect. Considering swallowing and gastroesophageal reflux together, a trunk angle of 60 degrees or more might be beneficial for reducing the risk of aspiration.

Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial.

Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer. This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction. This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0. The IED significantly reduced the occurrence of aspiration pneumonia ( P = .012), delayed the onset of aspiration pneumonia ( P = .005), and extended the survival time ( P = .007) in the experimental group. For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia. The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Effect of Conventional Speech Therapy Combined with Music Therapy on Swallowing in Patients with Parkinson's Disease (Telerehabilitation): A Randomized-Controlled Trial

Background: Swallowing difficulties or dysphagia is the main cause of aspiration pneumonia and death in patients with Parkinson's disease (PD). Although dysphasia occurs in 90% of patients with PD, there is insufficient evidence to support the effectiveness of behavioral speech therapy in this disease. Objectives: This study aimed to investigate the effect of a new telerehabilitation program that was a combination of speech and music therapy on dysphagia in patients with PD. Methods: This study was a 3-arm randomized controlled trial (RCT). Thirty-three subjects with PD (mean age, 58.88 years; 25 men and 8 women with complaints of swallowing problems) were randomly assigned to the combination therapy (including breathing, speech, voice, and singing exercises), conventional speech therapy, and music therapy groups. Each patient participated in 12 telerehabilitation sessions over 4 weeks. Swallowing Disturbance Questionnaire (SDQ) and dysphagia handicap index (DHI), as the outcomes of this study, were evaluated 1 week before the first intervention session, 1 week after the last intervention session, and 3 months after the last evaluation. Results: The results showed a significant improvement in SDQ and all sub-tests (functional, physical, and emotional), as well as the total score of DHI in the combination therapy and conventional speech therapy groups after treatment (P &lt; 0.05). Also, the music therapy group had a significant improvement in the SDQ score, emotional sub-test, and the total score of DHI (P &lt; 0.05). The combination therapy group demonstrated a significant outperform in the SDQ score compared to the other 2 groups, as well as in all sub-tests and the total score of DHI compared to the music therapy group (P &lt; 0.05). The combination therapy group also showed more improvement in all sub-tests, as well as the total score of DHI, compared to the music therapy group (P &lt; 0.05). The results also indicated that the speech therapy group had a more significant effect on the physical sub-test of DHI compared to the music therapy group (P &lt; 0.05). Conclusions: Although swallowing function improved in all 3 groups, this improvement was more in the combination therapy group than in the other groups. Therefore, it can be concluded that combination therapy has the potential to provide additional benefits for swallowing efficiency in this patient group. The results also suggest that the telerehabilitation method is feasible to deliver intensive therapy to individuals with PD to improve swallowing functions.

Evaluation of wiping edible sesame oils in the oral cavities of hospitalised older patients who resist oral hygiene management.

One of the causes of aspiration pneumonia is poor oral hygiene. We need care methods that caregivers can quickly, safely and inexpensively implement for convalescents with inadequate self-care. Edible sesame oil containing sesamin or sesaminol has already been shown to inhibit bacterial and fungal growth and have a vasodilating effect. The aim of this study is to evaluate the usefulness of using edible sesame oils for oral hygiene management. This study evaluates an oral hygiene management method using two types of sesame oils in elderly hospitalised patients resistant to oral hygiene management. The inpatients received oral care for 90 days. In the intervention groups, nurses brushed and wiped the oral cavity with roasted sesame oil (RSO) or sesame salad oil, while in the control group, care with tap water alone and brushing were done. Bacteria and Candida counts from tongue swabs, water content from the tongue's surface and cheek mucosa, oral health assessment tool (OHAT) and cytology of the cheek mucosa were assessed every 30 days before and after the intervention. RSO showed a tendency to reduce the number of bacteria and Candida. There was an improvement in the OHAT scores with both oils. The water content or cytology was not changing. Sesame oils may improve oral hygiene and maintain health in older patients.

P1-33: Careful history taking detects underlying disorders of initially unknown causes of aspiration pneumonia.

P1-33: Careful history taking detects underlying disorders of initially unknown causes of aspiration pneumonia.

Clinical Significance of Oral Care and Oral Management on the Treatment and Prevention of Aspiration Pneumonia in the Elderly: Evidences and Pitfalls

Oral care and oral management are important for preventing aspiration pneumonia (ASP). The main pathology of ASP is microaspiration of oropharyngeal contents during night, swallowing rehabilitation must be necessary for the ASP treatment. However, swallowing rehabilitation cannot totally restore the normal swallowing function. Oral healthcare management should be initiated and continued in parallel with antibiotic treatment of ASP. Oral care helps to prevent aspiration pneumonia by reducing oral bacteria, while oral management helps by improving masticatory and rehabilitating functions. The efficacy of oral care for reducing the incidence of pneumonia has been clearly observed in untreated frail elderly patients, but not in well-cared elderly persons. It has been established that oral care is cyclically significant for the prevention of ASP in the elderly. However, oral problems are not the primary cause of ASP in the elderly. Although there is an amount of evidences of oral care for ASP prevention, there are some controversies of the clinical significance of oral care for ASP treatment.

Careful history taking detects initially unknown underlying causes of aspiration pneumonia.

The majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively. This was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital-acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised. In total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug-induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms. In 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug-induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785-790.

Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons.

To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. The participants were 3475 independent Japanese elderly persons (≥65years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR=1.35; 95% CI=1.08-1.68), chewing ability (AOR=1.70; 95% CI=1.32-2.18), oral dryness (AOR=1.94; 95% CI=1.48-2.54), physical function (AOR=2.19; 95% CI=1.66-2.90), cognitive function (AOR=1.68; 95% CI=1.34-2.12) and depressive mood (AOR=1.82; 95% CI=1.41-2.35). Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65years.

Association between sarcopenia and pneumonia in older people.

Pneumonia is a major cause of death in older people, and the number of such deaths is increasing. Present guidelines for pneumonia management are based on a pathogen-oriented strategy that relies on the optimal application of antibiotics. Older pneumonia inpatients show the high incidence of aspiration pneumonia. The main cause of aspiration pneumonia is an impairment in the swallowing and cough reflexes. These facts suggest a limitation of present management strategies and a requirement for new strategies for aspiration pneumonia. Sarcopenia is the loss of muscle strength and mass, and declining physical function with aging. Recently, a decrease in the mass or strength of the swallowing muscles was suggested to be associated with reduced swallowing function. Accordingly, dysphagia caused by sarcopenia of the systemic and swallowing-related muscles was named sarcopenic dysphagia. Presently, few studies have shown associations between aspiration pneumonia and sarcopenic dysphagia. As for the cough reflex, strong cough prevents aspiration pneumonia, and its strength is regulated by respiratory muscles. A few studies have reported a relationship between muscles and pneumonia in older people. Sarcopenia is a risk factor for pneumonia in older people, and aspiration pneumonia inpatients with low muscle mass show high mortality rates. Aspiration pneumonia induced muscle atrophy in respiratory, swallowing, and skeletal muscles in an animal model and humans. Associations between respiratory muscle strength and pneumonia are currently under investigation. Evaluation and management of sarcopenia could potentially become a new strategy to prevent and treat pneumonia in older patients, and research has only recently been launched. Geriatr Gerontol Int 2020; 20: 7-13.

Fir branch as rare cause of aspiration pneumonia in adults

The article represents a clinical observation describing the case of mechanical obstruction in the respiratory passages with an unusual foreign body, a fir branch. The diagnostic problem lied in the fact that a patient did not notice the fact of aspiration, the respiratory symptoms were non-specific, and the foreign body was radiotransparent. A detailed case history allowed the detection and endoscopic confirmation of the aspiration of a foreign body, a fir branch, and the consideration of the community acquired pneumonia and secondary aspiration pneumonia that required specialized medical care by the thoracic surgery department.

An injection needle as a cause of aspiration pneumonia in a male HIV(+) intravenous drug user

An injection needle as a cause of aspiration pneumonia in a male HIV(+) intravenous drug user

Compensatory Mechanisms in Patients After a Partial or Total Glossectomy due to Oral Cancer.

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients' maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision.

Incidence and mortality trends of aspiration pneumonia in Parkinson's disease in the United States, 1979–2010

Careful examination of long-term analyses and trends is essential in understanding the medico-economic burden of this common complication. We sought to describe the long-term (32-year) trends of incidence and mortality in PD patients hospitalized with aspiration pneumonia (AsPNA). Incidence and mortality of AsPNA in hospitalized PD versus non-PD patients was assessed by logistic regression analysis applied to a national database between the years 1979 and 2010. Covariates such as age-decennium, gender, year AsPNA occurred, and the interactions with PD diagnosis were investigated. Rate of AsPNA and mortality over the 32-years was trended and compared. AsPNA occurred in 3.6% of PD patients and 1.0% of non-PD patients. The average mortality for PD patients was less (17% vs. 22%). Long-term (32-year) trends revealed a nearly 10-fold increase in incidence of AsPNA in PD (0.4% in 1979, 4.9% in 2010), decreasing mortality overtime, higher likelihood in males, and increasing average age of AsPNA patients (steeper increase in PD). All p-values<0.05. In regression analysis, each successive year had a slight increase in odds of AsPNA (OR 1.03 in PD, OR1.06 in non-PD). Trends over 32 years revealed a 10-fold increase in AsPNA among PD and non-PD patients, and an associated decrease in mortality. Our data suggest that PD patients are living longer, have slightly more AsPNA, but a lower mortality than was seen in past decades. Further research should investigate the causes of AsPNA in PD, and also potential interventions to decrease its occurrence.

Abstract T P331: Collaborative Multidisciplanary Approach in the Development and Implementation of an Aspiration Risk Tool Within a Certified Comprehensive Stroke Program

Background and Issues: Dysphagia is the leading neurological cause of aspiration pneumonia in stroke patients. Swallowing abnormalities are associated with a 3-fold higher mortality rate. Accreditation agencies and the American Stroke Association recommend institutions establish a dysphagia screening tool for stroke patients. Early identification decreases adverse health consequences and increases patient family satisfaction. Purpose: A multidisciplinary team of nurses and speech and language pathologists developed criteria to improve the identification of patients at risk for aspiration and created standardized tool. Methods: A review of the literature provided the frame work to formalize a screening tool. The tool assists the nurse in identifying patients at risk. The screening tool is divided into four sections; cognition, cough assessment, control of oral secretions and oral motor strength. It is required for the patient to pass all four levels. Failure to pass any one of the sections results in a formal dysphagia assessment. Patients that pass the four sections graduate to a water challenge. A cup containing 90cc of water is placed in front of the patient, and the patient is instructed to pick up the cup and take a drink. Nurses observe the patient’s ability to successfully coordinate the task. Observation of choking, coughing, nasal aspiration or requiring frequent verbal cues to swallow results in failure of the water challenge. The failing patient is kept NPO and a formal dysphagia assessment is ordered. Patients’ not exhibiting any signs of aspiration passes the screen. Results: The nursing staff recognized the importance of specific anatomical and mechanical components of dysphagia, which led to appropriate referrals to speech and language. Expedited referrals and reduced NPO time resulted in improved patient family satisfaction. Conclusion: Through a collaborative multidisciplinary team approach it is possible to develop and implement an evidenced based, reliable aspiration screening tool. This tool should not only be used for stroke patients but any person at risk for aspiration.

Determination of Candida species nestled in denture fissures

With the growing number of elderly individuals, Candida is occasionally recognised as a fungal cause of aspiration pneumonia. In addition, there are numerous investigational reports on oral candidiasis. However, there are currently no reports on Candida contamination of denture base materials. This study was conducted to investigate Candida species in the oral cavity, denture parts and oral lesions of older/elderly subjects with oral candidiasis. The Candida strains were isolated and the species identified. Candida was also cultured in a medium with sample of denture resin and observed under an electron microscope. The results demonstrated the presence of several Candida species in the lesions of the oral mucosa and the surface and inner portions of the dentures. The following species of Candida were detected: Candida albicans, Candida glabrata, Candida tropicalis and Candida parapsilosis. Using electron microscopy, the invasion of Candida was observed in the incomplete polymerized resin base material and/or through microcracks (fissures) that have a tendency to form in used dentures. It was concluded that Candida may be present on the surface as well as the deeper portions of dentures. In addition, it appeared necessary to consider denture and oral cavity cleaning and the risks of remaking old dentures.

Oral Motor Movements and Swallowing in Patients with Myotonic Dystrophy Type 1

Oropharyngeal dysphagia and esophageal motility disorders were found to be the most important causes of aspiration pneumonia in patients with myotonic dystrophy. The purpose of this report was to evaluate clinical characteristics of the oral motor movements and swallowing of individuals with myotonic dystrophy type 1 (DM1) using a standardized clinical protocol and surface electromyography (sEMG). Participants were 40 individuals divided in two groups: G1 composed of 20 adults with DM1 and G2 composed of 20 healthy volunteers paired by age and gender to the individuals in G1. Statistical analysis included one-way ANOVA with two factors for within- and between-group comparisons and Bonferroni correction for multiple comparisons. Patients with DM1 presented deficits in posture, position, and mobility of the oral motor structures, as well as compromised mastication and deglutition. The sEMG data indicated that these patients had longer muscle activations during swallowing events. The longer duration of sEMG in the group of patients with DM1 is possibly related to myotonia and/or incoordination of the muscles involved in the swallowing process or could reflect a physiological adaptation for safe swallowing.

Disseminated Aspergillosis Associated With Tsunami Lung

Many survivors of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011, contracted a systemic disorder called "tsunami lung," a series of severe systemic infections following aspiration pneumonia caused by near drowning in the tsunami. Generally, the cause of aspiration pneumonia is polymicrobial, including fungi and aerobic and anaerobic bacteria, but Aspergillus infection is rarely reported. Here we report a case of tsunami lung complicated by disseminated aspergillosis, as diagnosed during autopsy.

Preparative Fasting for Contrast-enhanced CT: Reconsideration

To evaluate the evidence on the value of preparative fluid fasting for patients undergoing elective computed tomography (CT) with intravenous administration of contrast material and to survey leading institutions in a number of countries on their current policies in this regard. This study qualified for exempt status by the institutional review board. First, 20 keyword combinations were entered into Medline to ascertain the correlation between fluid ingestion preceding contrast material-enhanced CT and development of aspiration pneumonia. The numbers of patients were summed up to estimate incidence of aspiration pneumonia attributable to ingestion of clear inert fluid before contrast-enhanced CT examination. Second, a multinational survey was conducted about the length of preparative fasting protocols, if any, for fluids and solids that they recommend to patients before elective non-gastrointestinal contrast-enhanced CT. Aspiration was not noted in any of 2001 patients (13 studies in the literature) who underwent contrast-enhanced CT after fluid ingestion. Data were available from 69 (86.3%) of 80 institutions queried (17 Korean, 14 U.S., 11 French, 10 Australian, 10 German, and seven Egyptian hospitals). Two-thirds (14 of 21 [66.7%]) of the French and German hospitals had a no-restriction policy for both fluids and solids, while Australian hospitals had a policy liberal about fluids (no restrictions in eight of 10 [80%]) only. Policies on fluids were variable in Korea, the United States, and Egypt (restrictions of 0-8 hours, 0-4 hours, and 0-6 hours, respectively), as were policies on solids in Korea, the United States, Australia, and Egypt (restrictions of 0-8 hours, 0-6 hours, 0 to 4-6 hours, and 0 hours to overnight, respectively). The length of fasting was longer for solids than for fluids in 20 hospitals. There is little evidence that ingestion of clear inert fluid prior to contrast-enhanced CT is a cause of aspiration pneumonia; the length of fasting is variable in any country, being much longer in some hospitals than in others.

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

Novel preventive and therapeutic strategy for post-stroke pneumonia

Pneumonia is a significant complication of ischemic stroke that increases mortality. Post-stroke pneumonia is defined as newly developed pneumonia following stroke onset. Clinically and chronologically, post-stroke pneumonia is divided into two types of aspiration pneumonia. First, acute-onset post-stroke pneumonia occurs within 1 month after stroke. Second, insidious or chronic-onset post-stroke pneumonia occurs 1 month after the stroke. The mechanisms of pneumonia are apparent aspiration and dysphagia-associated microaspiration. Stroke and the post-stroke state are the most significant risk factors for aspiration pneumonia. The preventive and therapeutic strategies have been developed thoroughly and appropriate antibiotic use, and both pharmacological and nonpharmacological approaches for the treatment of post-stroke pneumonia have been studied rigorously. Increases in substance P levels, oral care, and swallowing rehabilitation are necessary to improve swallowing function in post-stroke patients, resulting in a reduction in the incidence of post-stroke pneumonia in a chronic stage. The stroke must be a cause of aspiration pneumonia.