Complications and Outcome After Acute Stroke

Smithard, DG; O'Neill, PA; Parks, C; Morris, Julie

doi:10.1161/01.str.27.7.1200

Cited by 601 publications

(198 citation statements)

References 13 publications

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“…Only 12% did not recover and continued to have complaints relating to swallowing. These results were in agreement with other studies that showed that recovery of swallowing occurred over the first few weeks after the event, and that swallowing disorders only remained in a small number of patients 9,10,13,14 . A study using functional magnetic resonance imaging among dysphagia patients showed that among patients who had recovered within a short period of time, cortical maps in the hemisphere not affected by stroke explained this as reorganization in the cortex 5 .…”

Section: Discussionsupporting

confidence: 93%

“…Such cases would be more likely to show abnormalities of swallowing. Our patients were seen at the clinic within 30 days after hospital discharge, which was in accordance with the literature, which shows that swallowing disorders are greatest in severe stroke cases and in the acute phase of stroke 13 .…”

Section: Discussionsupporting

confidence: 90%

“…This finding was concordant with the literature, which shows that dysphagia may be associated with aspiration of saliva or food and can cause lung infections, dehydration and mal-nutrition. It is thus an independent sign of worse outcomes and increased mortality after stroke 12,13 . Recognizing this is extremely important for the performance of the speech therapy team in relation to stroke patients, in order to prevent and reduce hospital admissions and readmissions due to aspiration pneumonia, thereby aiming to stabilize the nutritional characteristics and improve the patients' quality of life 24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…It has also been shown that, six months after the stroke, deglutition abnormalities are present in 50% of such patients 9,13,14 .…”

mentioning

confidence: 99%

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Swallowing disorders after ischemic stroke

Remesso

Fukujima²,

Chiappetta

et al. 2011

Arq. Neuro-Psiquiatr.

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Objective: To investigate occurrences of swallowing disorders after ischemic stroke. Method: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. Results: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7) (p≤0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p≤0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p≤0.001). Conclusion: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…It has also been shown that, six months after the stroke, deglutition abnormalities are present in 50% of such patients 9,13,14 .…”

mentioning

confidence: 99%

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Swallowing disorders after ischemic stroke

Remesso

Fukujima²,

Chiappetta

et al. 2011

Arq. Neuro-Psiquiatr.

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“…Neverthless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period.The data reinforces the importance of repeated evaluations made by different professionals of the sttaff involved in acute stroke attendance.KEY WORDS: epidemiology, oropharyngeal dysphagia, stroke.A disfagia é reconhecida como um dos principais fatores de risco para ocorrência de pneumonia aspirativa 1,2 , uma das complicações mais freqüentes dos acidentes vasculares do encéfalo (AVEs), principal causa de morte no Brasil 3 . Barreto 4 chamava a atenção para a freqüência e gravidade de disfagia após AVEs e para a necessidade do pronto reconhecimento e tratamento adequado.…”

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Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

Schelp

Cola

Gatto

et al. 2004

Arq. Neuro-Psiquiatr.

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RESUMO -A doença vascular encefálica (AVE) é a principal causa de morte no Brasil.As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50% dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5% dos pacientes avaliados clinicamente, este percentual elevando-se a 91% com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.PALAVRAS-CHAVE: epidemiologia, disfagia orofaríngea, acidente vascular encefálico. Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State -BrazilABSTRACT -Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to stablish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions.The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Neverthless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period.The data reinforces the importance of repeated evaluations made by different professionals of the sttaff involved in acute stroke attendance.KEY WORDS: epidemiology, oropharyngeal dysphagia, stroke.A disfagia é reconhecida como um dos principais fatores de risco para ocorrência de pneumonia aspirativa 1,2 , uma das complicações mais freqüentes dos acidentes vasculares do encéfalo (AVEs), principal causa de morte no Brasil 3 . Barreto 4 chamava a atenção para a freqüência e gravidade de disfagia após AVEs e para a necessidade do pronto reconhecimento e tratamento ade...

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Breathing and Swallowing Dynamics Across the Adult Lifespan

Martin‐Harris¹,

Brodsky²,

Michel³

et al. 2005

Arch Otolaryngol Head Neck Surg

244

251

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Background: Aberrations in the physiologic components of normal oropharyngeal swallowing have been linked to aspiration events and to predisposition to aspiration pneumonia, a common, deadly disease in elderly persons. Studies have demonstrated a temporal, physiologic link between breathing and the principal physiologic swallowing components involved in airway protection during swallowing. We developed a normative model of integrated breathing and swallowing patterns using concomitant videofluoroscopic images and nasal respiratory airflow recordings.Objectives: To establish normative temporal and respiratory-phase pattern relationships between breathing and swallowing in adult human beings across the aging continuum; to relate any alterations in these patterns to swallowing abnormality, an aspiration event during swallowing, and predisposition to aspiration pneumonia; and to develop clinically practical evaluation methods for identifying breathing and swallowing discoordination.Setting: Fluoroscopy suite in an acute care hospital.Participants: Eighty-two healthy adult volunteers gave informed consent. All eligible healthy volunteers were welcome and were screened for age, race, and sex for equal distribution of each.Intervention: Respiratory-phase patterns and the onset and duration of 11 predetermined swallowing events and associatedrespiratoryactivitieswerestudied.Allparticipants' single-liquidbariumswallowexaminationswerestudiedwith simultaneous videofluoroscopy and respiratory recordings.Main Outcome Measures: Onset of each of the 11 predetermined breathing and swallowing events was digitally recorded and analyzed. The phases of breathing before and after swallowing were identified. The presence, depth, and response to airway penetration were recorded and related to respiratory pattern.Results: Four respiratory-phase patterns were identified that changed with advanced age. The correlation analyses of the temporal breathing and swallowing events revealed a normal pattern of 4 clearly distinguishable functional units. Differences in apnea duration and apnea offset occurred with advanced age. Conclusion:This research provides evidence for clearly distinguishable patterns and functional groupings of breathing and swallowing events, a necessary first step toward determining whether abnormal breathing and swallowing patterns in patients with dysphagia are associated with health outcome.

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Complications and Outcome After Acute Stroke

Abstract: Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.

Cited by 601 publications

References 13 publications

Swallowing disorders after ischemic stroke

Swallowing disorders after ischemic stroke

Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

Breathing and Swallowing Dynamics Across the Adult Lifespan

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