Aspiration pneumonias are frequent complications of cerebrovascular accidents (CVA). They occur mainly in patients suffering from swallowing disorders following the CVA. These patients can be diagnosed using a bedside swallowing evaluation. This evaluation is based on observation of some components of the oral and pharyngeal stages of the swallowing process and on a drinking test of 50 ml3 of clear liquids. Changing the mode of swallowing and the consistency of the diet according to the swallowing evaluation following CVA can reduce significantly the frequency of aspiration pneumonias. In our patient cohort, consisting of 180 patients admitted for stroke rehabilitation, aspiration pneumonias occurred in 10% and swallowing disorders were found in 28%. The administration of a structured swallowing evaluation was associated with a gradual reduction of frequency of pneumonia from 16% in the first group of 60 patients to 3% in the last group of 60 patients or, if considering only patients suffering from dysphagia, from 27% in the first group of patients to none in the last group of patients.
Effective and efficient conduction of stroke rehabilitation depends on the ability to predict outcome. Complicated impairment and disability scales enable such a prediction but are difficult to implement, particularly at acute care facilities, where such predictions should be performed. We evaluated the use of a relatively simple, previously reported impairment classification on a general unselected stroke rehabilitation patient population. This classification is based on the presence on examination of motor, somatosensory, and visual field deficits. We found that it was able to predict functional level on admission and on discharge, length of stay in hospital, and discharge destination. This impairment classification scale may be used to improve the organization of inpatient stroke rehabilitation.
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