Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Jones, Corinne A.; Colletti, Christina M.; Ding, Ming-Chieh

doi:10.1007/s11910-020-01081-z

Cited by 84 publications

(79 citation statements)

References 98 publications

(101 reference statements)

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“…To date, current negative predictors of swallowing recovery in patients with COVID‐19 are unknown; however, there is a wide range of current negative predictors of swallowing recovery post stroke, including older age, higher NIHSS score, greater lesion volume, lesion location, presence of dysarthria, and concern for aspiration on initial assessment 47,48 . Therefore, discussions regarding alternate nutrition primarily rely on multi‐disciplinary clinical judgement.…”

Section: Clinical Considerationsmentioning

confidence: 99%

Speech‐language pathology approaches to neurorehabilitation in acute care during COVID‐19: Capitalizing on neuroplasticity

Langton-Frost

Brodsky

2021

PM&R

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Neurologic manifestations associated with a coronavirus disease 2019 (COVID‐19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID‐19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech‐language pathologists are an integral part of both the critical care and neurologic disorders multi‐disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech‐language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive‐linguistic impairments such as aphasia, thereby increasing the need for communication‐based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID‐19 often experience physical, cognitive, and mental health impairments collectively called post‐intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech‐language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.

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Section: Clinical Considerationsmentioning

confidence: 99%

Speech‐language pathology approaches to neurorehabilitation in acute care during COVID‐19: Capitalizing on neuroplasticity

Langton-Frost

Brodsky

2021

PM&R

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“…Vacuum swallowing is a novel compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure in the esophagus in patients who have dysphagia due to LMS. [ 1 , 8 , 9 ] In this swallowing method, a bolus is sucked from the pharynx into the esophagus due to a pressure gradient despite weak pharyngeal contraction and impaired upper esophageal sphincter (UES) function.…”

Section: Introductionmentioning

confidence: 99%

Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome—vacuum and prolonged swallowing

Kunieda

Sugiyama²,

Nomoto

et al. 2022

Medicine

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Introduction: The nature of pharyngeal swallowing function during the course of recovery of dysphagia due to lateral medullary syndrome (LMS) is unclear. Vacuum swallowing is a compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure during swallowing in the esophagus in patients with dysphagia due to LMS. We present a case involving a patient with dysphagia due to LMS who involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. Patient concerns: We report a unique case involving a 52-year-old patient with dysphagia due to LMS. His dysphagia was severe but improved gradually with swallowing rehabilitation. The patient involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. Diagnosis: The patient presented with dysphagia due to left LMS. A videofluoroscopic examination of swallowing revealed pharyngeal residue. Interventions: Forty-five days after the onset of the dysphagia, the swallowing pressure along the pharynx and esophagus was measured using high-resolution manometry. Outcomes: Vacuum swallowing was observed in six out of 19 swallows (32.5%). The velopharyngeal contractile integral (CI) and mesohypopharyngeal CI values increased during swallowing, reflecting prolonged and increased pharyngeal contraction. We named this swallowing method “prolonged swallowing.” Conclusion: The findings in this case indicate that vacuum and prolonged swallowing may be compensatory swallowing methods observed in individuals recovering from dysphagia due to LMS. Further research is needed to clarify the relationship between these swallowing methods and the pathophysiology, prognosis, and treatment of dysphagia in patients with LMS.

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“…Stroke is the main cause of dysphagia ( Jones et al, 2020 ), with an incidence rate of 30–40% ( Bussell and González-Fernández, 2011 ; Meng et al, 2020 ). Dysphagia after stroke leads to many adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

et al. 2022

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Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown.Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy.Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure.Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37–0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18–39, 40–59, 60–79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000).Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings.Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.

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Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Cited by 84 publications

References 98 publications

Speech‐language pathology approaches to neurorehabilitation in acute care during COVID‐19: Capitalizing on neuroplasticity

Speech‐language pathology approaches to neurorehabilitation in acute care during COVID‐19: Capitalizing on neuroplasticity

Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome—vacuum and prolonged swallowing

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

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