Swallowing and Stroke

Smithard, David

doi:10.1159/000063716

Cited by 47 publications

(8 citation statements)

References 40 publications

(78 reference statements)

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“…Stroke is commonly associated with multiple forms of disability, including dysphagia, which is experienced by approximately half the patients in acute phase, 10-20% of patients after 2 weeks, and 11-13% after 6 months (Smithard, 2002). Post-stroke dysphagia also increases the risks of aspiration pneumonia, malnutrition, and mortality (Wade and Hewer, 1987;Axelsson et al, 1989;Kidd et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities

Katagiri

Shiba

Tohara

et al. 2019

Front. Cell. Infect. Microbiol.

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Stroke is associated with multiple forms of disability, including dysphagia. Post-stroke dysphagia increases the risks of pneumonia and mortality and often results in cessation of oral feeding. However, appropriate rehabilitation methods can eventually lead to resumption of oral food intake. This study tried to clarify that re-initiating oral food intake could modify the composition of oral/gut microbial communities in patients with dysphagia. From 78 patients with sub-acute stage of stroke, 11 complete tube feeding subjects without taking antibiotics were enrolled and received rehabilitation for re-initiation of oral food intake, and 8 subjects were brought back to complete oral feeding. Oral and gut microbiota community profiles were evaluated using 16S rRNA sequencing of the saliva and feces samples before and after re-initiation of oral food intake in patients recovering from enteral nutrition under the same nutrient condition. Standard nutrition in the hospital was 1,840 kcal, including protein = 75 g, fat = 45 g, and carbohydrates = 280 g both for tube and oral feeding subjects. Oral food intake increased oral and gut microbiome diversity and altered the composition of the microbiome. Oral and gut microbiome compositions were drastically different; however, the abundance of family Carnobacteriaceae and genus Granulicatella was increased in both the oral and gut microbiome after re-initiation of oral food intake. Although oral microbiota showed more significant changes than the gut microbiota, metagenome prediction revealed the presence of more differentially enriched pathways in the gut. In addition, simpler co-occurrence networks of oral and gut microbiomes, indicating improved dysbiosis of the microbiome, were observed during oral feeding as compared to that during tube feeding. Oral food intake affects oral and gut microbiomes in patients recovering from enteral nutrition. Rehabilitation for dysphagia can modify systemic health by increasing the diversity and altering the composition and co-occurrence network structure of oral and gut microbial communities.

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Section: Introductionmentioning

confidence: 99%

Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities

Katagiri

Shiba

Tohara

et al. 2019

Front. Cell. Infect. Microbiol.

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“…Dysphagia is important because of its association with poor functional status in many cases [4] and increased morbidity and mortality [11]. Malnutrition and dehydration are common in people with dysphagia due to poor access to food and fluids or poor intake secondary to modified diets and fluids [12]. It is considered likely that many older people admitted to hospital with pneumonia will have an underlying problem with dysphagia [13,14].…”

Section: Swallowing Problemsmentioning

confidence: 99%

“…Following acute stroke, many people will recover their ability to swallow safely spontaneously [12], and following frailty decompensation this may occur also. For others, a period of rehabilitation may be appropriate [22].…”

Section: Swallowing Problemsmentioning

confidence: 99%

Optimising Medicines Administration for Patients with Dysphagia in Hospital: Medical or Nursing Responsibility?

2020

Self Cite

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Dysphagia is common—not only associated with stroke, dementia, Parkinson’s but also in many non-neurological medical problems—and is increasingly prevalent in ageing patients, where malnutrition is common and pneumonia is frequently the main cause of death. To improve the care of people with dysphagia (PWD) and minimise risk of aspiration and choking, the textures of food and drinks are frequently modified. Whilst medicines are usually concurrently prescribed for PWD, their texture is frequently not considered and therefore any minimisation of risk with respect to food and drink may be being negated when such medicines are administered. Furthermore, evidence is starting to emerge that mixing thickeners with medicines can, in certain circumstances, significantly affect drug bioavailability and therefore amending the texture of a medicine may not be straightforward. Research across a number of hospital trusts demonstrated that PWD are three times more likely to experience medication administration errors than those without dysphagia located on the same ward. Errors more commonly seen in PWD were missed doses, wrong formulation and wrong preparation through medicines alteration. Researchers also found that the same patient with dysphagia would be given their medicines in entirely different ways depending on the person administering the medicine. The alteration of medicines prior to administration has potential for patient harm, particularly if the medicine has been designed to release medicines at a pre-defined rate or within a pre-defined location. Alteration of medicines can have significant legal implications and these are frequently overlooked. Dispersing, crushing or mixing medicines can be part of, or misconstrued as, covert administration, thus introducing a further raft of legislation. Guidance within the UK recommends that following identification of dysphagia, the ongoing need for the medicine should be considered, as should the most appropriate route and formulation, with medicines alteration used as a last resort. The patient should be at the centre of any decision making. Evidence suggests that in the UK this guidance is not being followed. This article considers the clinical and legal issues surrounding administration of medicines to PWD from a UK perspective and debates whether medicines optimisation should be the primary responsibility of the prescriber when initiating therapy on the ward or the nurse who administers the medicine.

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“…The process of swallowing has been described as the most complex of "all or nonrefl ex" [ 130 , 131 ]; however, although the pharyngeal swallow is a basic refl ex, feedback regarding bolus size and viscosity emanating from afferents in the mouth and pharynx [ 132 ] regarding bolus size and viscosity via the cortex will modify timings of various components of the swallow.…”

Section: Swallowingmentioning

confidence: 99%

Swallowing and Nutritional Complications

Smithard

Weekes

2015

Management of Post-Stroke Complications

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Malnutrition and dysphagia are common after stroke and frequently occur together. Failure to recognise their presence and manage them effectively will result in increased morbidity and mortality. Infection risk may be raised, recovery and rehabilitation will be slowed, and people will be more likely to end up in longterm care. Treatment of malnutrition and swallowing diffi culties requires early recognition, e.g. through routine screening procedures, and their management requires input from the multi-disciplinary team.Monitoring of nutrition and swallowing status needs to be regular and consistent and may need to continue beyond hospital discharge into the care home environment and in those living at home. Consequently, issues around the detection and management of malnutrition and dysphagia need to be raised with all care staff and professionals.

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Swallowing and Stroke

Cited by 47 publications

References 40 publications

Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities

Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities

Optimising Medicines Administration for Patients with Dysphagia in Hospital: Medical or Nursing Responsibility?

Swallowing and Nutritional Complications

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