Swallowing Function After Stroke

Abstract

Background and Purpose-Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after acute stroke and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications. Methods-We prospectively assembled an inception cohort of 128 hospital-referred patients with acute first stroke. We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of stroke onset, using standardized methods and diagnostic criteria. All patients were followed up prospectively for 6 months for the occurrence of death, recurrent stroke, chest infection, recovery of swallowing function, and return to normal diet. Results-At presentation, a swallowing abnormality was detected clinically in 65 patients (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 patients (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 patients (20%; 95% CI, 14% to 28%) suffered a chest infection. At 6 months after stroke, 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 patients (50%; 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 patients who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 patients and aspiration in another 17. The single independent baseline predictor of chest infection during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, chest infection, or aspiration at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the laryngeal vestibule, age Ͼ70 years, and male sex. Conclusions-Swallowing function should be assessed in all acute stroke patients because swallowing dysfunction is common, it persists in many patients, and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing abnormalities and complications are videofluoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies. (Stroke. 1999;30:744-748.)

Screening oropharyngeal dysphagia in hospitalized older adults: A prevalent problem associated with mortality

“…OD does not only cause swallowing difficulties (malnutrition, and dehydration), but also has the potential to cause serious complications such as dehydration and aspiration pneumonia [22]. However, such an association was not observed in our study, which was probably related to the low prevalence (2.9% vs. 11.8 %) of each condition.…”

Pneumonia in acute stroke patients fed by nasogastric tube

“…The diagnosis was based on three or more of the following variables: fever (.38˚C), productive cough with purulent sputum, abnormal respiratory examination (tachypnoea (.22 breaths/min), tachycardia, inspiratory crackles, bronchial breathing), abnormal chest radiograph, arterial hypoxaemia (PO 2 ,9.3 kPa), and isolation of a relevant pathogen (positive Gram stain or culture). 4 If endotracheal intubation and artificial ventilation became necessary, the suspected reason was noted. Pneumonia acquired after endotracheal intubation was not considered for further analysis.…”

“…Frequently encountered consequences are incomplete oral clearance, pharyngeal pooling, regurgitation, and aspiration. [1][2][3][4][5] In the acute stage of the illness, dysphagia is found in up to 50% of stroke patients, depending on the timing of the assessment, the diagnostic methods used, and the case mix. 4 6-8 Dysphagic symptoms resolve in most patients within a week to a month and persist in only a small number of subjects beyond six months.…”

Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

“…Outros autores, como Mann e col. 13 em análise de 128 pacientes, no período de um ano, encontraram disfagia, determinada clinicamente, em 65 (51%) pacientes. No estudo referido, foi realizada avaliação no leito, com mediana de 3 dias.…”

“…A m a i o r s e n s i b i l i d a d e d o e x a m e videofluoroscópico permite detectar tanto formas leves de disfagia, como alterações de fase faríngea dificilmente visualizadas pela avaliação clínica 14 . Mann e col. 13 estudaram 161 pacientes pós AVE, clínica e videofluoroscopicamente, e também encontraram maior incidência de disfagia através do exame objetivo (64%), em comparação com os 51% detectados na avaliação clínica.…”