Recent developments in diagnosis and intervention for aspiration and dysphagia in stroke and other neuromuscular disorders

Abstract

This review discusses the impact of the evidence-based report on dysphagia diagnosis and treatment in stroke patients prepared in 1999 by ECRI under contract with the Agency for Healthcare Research and Quality (AHRQ). Subsequent research findings are highlighted and research design and reporting problems in the field are discussed. Progress has been made toward standardizing training and rating of videofluoroscopic studies of swallowing (VFSS); however, a consensus does not yet exist. A randomized, controlled trial demonstrated that treatment directed by fiber-optic endoscopic evaluation of swallowing with sensory testing (FEESST) or VFSS resulted in approximately equivalent pneumonia rates. These two different methods provide both overlapping and complementary information. There is discussion of the research design problems of mixed patients versus homogeneous populations, case-control diagnostic studies, inappropriate calculations of diagnostic sensitivity/specificity using imperfect "gold standards," the lack of concurrent control groups in treatment studies, and the misuse of statistical significance tests and P values in examining matching of patient characteristics in comparative studies and in identifying important variables in regression analysis.

Screening Accuracy for Aspiration Using Bedside Water Swallow Tests

“…To date, most research has not examined the accuracy of specific tests, lacked comparison with an a priori reference standard, and/or lacked a systematic evaluation process, [14][15][16][17][18][19][20][21][22][23] leaving clinicians without guidance. 24 The aim of this review is to evaluate the clinical utility of a single test, the water swallow test (WST), and determine its diagnostic accuracy for identifying patients who are aspirating.…”

Speech Impairment, Phonation, Writing, Salivation, and Swallowing in Patients with Parkinson’s Disease

“…Studies suggest that 40% of adults aged 60 and older have dysphagia [38,39]. Stina [40] investigated the connection between swallowing functions and quality of life in patients with PD.…”

ADI nutritional recommendations for dysphagia

“…A considerable number of studies, particularly between 1980 and 2000, describing specific tests dedicated to the management of dysphagia, were found on Medline and Cinhal using the keyword "dysphagia" [8][9][10]. 4.…”

“…If the impediment is for a short or uncertain time (2-4 weeks) then enteral nutrition via a nasogastric tube should be started and indeed in acute stroke, for example, this can even be considered to lead to a superior outcome [10]. If dysphagia persists it would be wise to evaluate the indications for the placement of an endoscopic gastrostomy PEG.…”