Predictors of survival after severe dysphagic stroke

Ickenstein, Guntram W.; Stein, Joel; Ambrosi, Denise; Goldstein, Richard; Horn, Markus; Bogdahn, Ulrich

doi:10.1007/s00415-005-0906-9

Cited by 80 publications

(43 citation statements)

References 29 publications

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“…In addition, the size of the lesion is considered to be more important than its location for the development of oropharyngeal dysphagia (29) . In the present study, the possibility of mortality was found to be higher among patients with swallowing dysfunction, as previously described (16) , generally associated with aspirative pneumonia. Patients with dysphagia after a stroke are at a 6-to 7-fold higher risk to develop aspirative pneumonia and at a 3-fold higher risk to die (42) .…”

Section: Discussionsupporting

confidence: 88%

“…These values refer to clinical evaluation since no objective exam was used, which might have revealed silent aspirations not detected by clinical evaluation. Although the sensitivity and specificity of this evaluation is variable (43) , with no detection of silent aspiration, its reliability has been widely reported (32) , as well as its contribution to the diagnosis, planning during the objective exam and the definition of therapy (1,16) . There are some published protocols to evaluate the intensity of dysphagia (4,30,(38)(39)(40) , but there is no perfect agreement between them (41) , which indicates the need to discuss the importance of the protocols used to evaluate oropharyngeal dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…However, most studies report that patients with lesions in the right hemisphere have more swallowing dysfunction (44) . It was described that lesions located in the right hemisphere cause more pharyngeal changes and that lesions in the left hemisphere cause more changes in the oral phase of swallowing (16) . Other studies on patients with stroke did not observe a relation between the presence of dysphagia and right or left hemispheric location (13,29,36,46) .…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for swallowing dysfunction in stroke patients

Baroni

Fábio

Dantas

2012

Arq. Gastroenterol.

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-Context -Stroke is a frequent cause of dysphagia. Objective -To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. Methods -Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. Results -It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. Conclusions -Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death. HEADINGS -Stroke. Deglutition disorders.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for swallowing dysfunction in stroke patients

Baroni

Fábio

Dantas

2012

Arq. Gastroenterol.

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“…The severity of the cases has an influence on the following procedures and determines variations on the others indicators. For example, determining the functional outcomes associated with cognitive measurements can play an important role in predicting and treating swallowing as well as improving survival during neurorehabilitation (13) .…”

Section: Discussionmentioning

confidence: 99%

Indicadores de qualidade para o gerenciamento da disfagia em Unidades de Internação Hospitalar

Moraes

Andrade

2011

J. Soc. Bras. Fonoaudiol.

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This article proposes a panel of quality indicators for the management of swallowing rehabilitation (SR) therapy in a hospital setting. There were four stages in developing these indicators: identifying procedures to be managed; generating indicators and standardizing data collection; identifying the correlation among indicators; and formulating the panel of indicators. The following 12 quality indicators were developed: swallowing evaluation index; individual care index; speech-language pathologist (SLP) care index; number of assisted patients index; severity rate; swallowing diagnosis rate per hospital unit; swallowing rehabilitation demand index; time until first swallowing evaluation; SLP index per hospital bed; time until removal of feeding tube; time until reintroduction of oral feeding; and time until decannulation. The proposed indicators were designed to improve the management of dysphagia in a hospital setting. Measuring these indicators is essential to understanding the patient's needs and providing quality care. Managing care using these indicators will make it easier to track the patient's rehabilitation process, measure the effectiveness of new therapeutic processes and technologies, and evaluate the performance of hospital units relative to other providers in the area. The management of SR using quality indicators allows the effectiveness and efficiency of rehabilitation programs to be clearly evaluated. RESUMOEste estudo propõe um painel de indicadores de desempenho para a gestão de um programa de reabilitação da deglutição (PRD) em ambiente hospitalar. Para a elaboração do painel de indicadores foram estabelecidas quatro fases: identificação de processos a serem gerenciados; elaboração dos indicadores e padronização de obtenção dos dados; classificação e proposição de correlação de indicadores; elaboração do painel de indicadores. Os resultados apontam 12 indicadores: índice de avaliação da deglutição; índice de atendimento por paciente; índice de atendimento por fonoaudiólogo; índice de pacientes atendidos; taxa de gravidade; taxa de avaliação por unidade de internação hospitalar; índice de demanda para reabilitação da deglutição; tempo para avaliação da deglutição; índice de fonoaudiólogo por leito; tempo para retirada da via alternativa de alimentação; tempo para o retorno da alimentação por via oral; tempo para decanulação. O processo de medição de indicadores é essencial para entendimento e gerenciamento da disfagia em ambiente hospitalar e delineamento da qualidade. O gerenciamento por indicadores padronizados favorece a análise do desempenho ao longo do tempo, frente à inclusão de novos processos ou tecnologias, e a comparação a outros Serviços julgados como referências no setor. Este gerenciamento contribui para que a eficácia e eficiência dos programas de reabilitação sejam evidenciadas.

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“…These are mainly neurological such as stroke or cerebrovascular accident, brain injury from trauma or bleeding, degenerative diseases such as Alzheimer's disease, neuromuscular disorders such as Parkinson's disease or mechanical such as cancer, oral trauma and/or surgery, craniofacial abnormalities (Ney et al 2009;Speech Pathology Australia 2004). Of these stroke is estimated to be the most common cause of dysphagia (Ickenstein et al 2005). Stroke is also the leading cause of long-term disability in Australian adults, and represents 25% of all chronic disability (Australian Institute of Health and Welfare 2003).…”

Section: Dysphagiamentioning

confidence: 99%

Insights into rational design of plant based foods to improve management of dysphagia

Tobin¹

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Normal swallowing is a complex process which requires sufficient mastication and lubrication of the food to transport the bolus from the mouth to the pharynx. In people suffering from dysphagia this process is not well coordinated and they often have difficulty in transporting food and water from the mouth to the stomach, which can lead to choking or aspiration. Modification of food texture by mincing or pureeing normal food is used to prevent these complications; however inconsistencies in texture can affect the consumption of these foods. Hence, malnutrition, dehydration and aspiration pneumonia, are a common problem with dysphagia sufferers.Using green peas as a model food system, this project investigated the effect of three method of comminution -mincing, pureeing and freeze-fracturing (processing whilst frozen) -on the macro and microstructure of the peas and its impact on rheological behaviour and sensory perception.Comminution of peas resulted in a particulated soft solid with hierarchical structures with broad range of particle sizes and shapes i.e. from large clusters of cells (5 mm) to starch granules (10 µm) which were released from broken cells. These pea particles were suspended in serum released during cellular structure breakdown. The high concentration, broad particle size distributions, variations in morphology and deformability of particles made this system complex and challenging to measure. Vane geometry was used to evaluate the rheological behaviour of comminuted peas, as it enabled accurate measurement of dispersions containing large particles without altering the product structure and it also eliminated any wall slip effects. The effect of pea variety, particle size distribution and amount of serum or added water on rheological behaviour was studied.Results demonstrated that comminuted peas were characteristically solid-like with higher elastic than viscous modulus (G´ > G˝). They also exhibited a yield stress which is an important parameter in these systems as it is a good indicator of the amount of effort required to initiate flow during oral processing. Minced peas with over 50% of the particle >1 mm in size had broader size distribution, which packed better than narrower distributions of pureed peas, resulting in higher G´ and yield stress. Changing the particle size distributions by systemically increasing the percentage of minced peas in a mince/puree blend also increased G´ and yield stress. This indicated that particle size distribution can be used to modify flow behaviour, while keeping the solids content the same.Diluting minced and pureed peas with incremental amounts of water showed that in such concentrated systems, small changes in solid to liquid ratio had a considerable impact on G´ and yield stress, as small increments in the liquid phase decreased G´ and yield stress dramatically. The variety of pea did not impact on the particle size distribution, but it affected the amount of serum released and particle firmness. These findings showed that particle concentratio...

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Predictors of survival after severe dysphagic stroke

Cited by 80 publications

References 29 publications

Risk factors for swallowing dysfunction in stroke patients

Risk factors for swallowing dysfunction in stroke patients

Indicadores de qualidade para o gerenciamento da disfagia em Unidades de Internação Hospitalar

Insights into rational design of plant based foods to improve management of dysphagia

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