Dysphagia Management in Acute and Sub-acute Stroke

Abstract

Swallowing dysfunction is common after stroke. More than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months. The physiologic impairments that result in post-stroke dysphagia are varied. This review focuses primarily on well-established dysphagia treatments in the context of the physiologic impairments they treat. Traditional dysphagia therapies including volume and texture modifications, strategies such as chin tuck, head tilt, head turn, effortful swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver and exercises such as the Shaker exercise and Masako (tongue hold) maneuver are discussed. Other more recent treatment interventions are discussed in the context of the evidence available.

Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia

“…Traditional dysphagia therapies include postural interventions, swallowing maneuvers, and exercises. Although these interventions have been used in clinics worldwide, evidence of their effectiveness is still scarce [3][4][5]. Transcranial magnetic stimulation (TMS) is a method used to modulate brain activities in a specific cortico-subcortical network [6].…”

Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke

“…Reports suggest differences in hyoid and laryngeal displacement but are mixed (Table 1) [11, 15–18]. A more comprehensive understanding of covariant swallowing mechanics including hyoid and laryngeal movement, tongue base retraction, pharyngeal shortening, and head and neck extension could not only highlight the dysfunction underlying stroke-associated penetration and aspiration, but also suggest which treatment goals would be more salient [19, 20]. …”

Biofeedback eletromiográfico no tratamento das disfunções orofaciais neurogênicas: revisão sistemática de literatura

“…The Shaker maneuver aims to improve the laryngeal elevation and increase the efficiency of the protective mechanisms of the airways, by working the extrinsic muscles of the larynx. In this maneuver, the patient should be lying without a pillow and lift his head, looking at his feet, without lifting his shoulders (24) . In most studies (80%), the electrodes were placed on submental muscles, the suprahyoideus (14,16,17,18) and in 20% of the studies, between the hyoid bone and the upper edge of the thyroid cartilage (15) .…”