Critical Review: Factors Associated with Dysphagia Assessed via Videofluoroscopy (original) (raw)
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Geriatrics
The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management ...
Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients
Stroke, 2003
Background and Purpose— Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians. Methods— An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted. Results— Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (κ=0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (κ=0 to 0.75) in the absence of assessor training. Fiberoptic endo...
Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients
2000
Objective: To use an established dysphagia clinical screening system to evaluate outcomes in acute stroke patients. Design: Case-control study. Setting: Tertiary care center. Participants: Acute stroke patients (n ϭ 56) consecutively referred to a speech pathology service. Main Outcome Measures: Outcomes (ie, pneumonia, dietary status at discharge) in patients who were referred for a videofluoroscopic swallow study (VSS) based on results of a previously validated clinical screening system were compared with outcomes in patients who were not referred for VSS based on the clinical evaluation. Results: Thirty-eight of 56 patients (68%) presented with 2 or more clinical predictors of moderate to severe dysphagia and were further evaluated with VSS, whereas 18 patients (32%) had fewer than 2 clinical features and were not evaluated radiographically. Based on patient outcomes and VSS results, identification of at least 2 clinical predictors significantly distinguished patients with moderate to severe dysphagia from patients with mild dysphagia or normal swallowing. None of the patients in either group developed pneumonia while following recommendations of the clinical or dynamic swallowing evaluation, and 93% of the patients returned to a regular diet. Conclusions: These data demonstrate that clinical use of this screening system can objectively identify acute stroke patients who warrant further diagnostic studies and can safely determine which patients need no further deglutitive evaluation.
Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management
International Journal of Phonosurgery & Laryngology, 2021
Original research language pathologist in which various maneuvers could be elicited on patients to assess which method would be more helpful in improving their symptom. During FEES, we closely monitored SPO 2 (oxygen saturation) of our patients. The three scales considered were penetration aspiration scale, secretion rating scale, and residue rating scale. According to the severity of score, patients were given compensatory and rehabilitative swallowing therapy. • Stroke severity was assessed by NIHSS score. • Location of stroke was done on the basis of computed tomography (CT) scan of the brain. The primary aim of our study was to assess the incidence of dysphagia in acute stroke patients and analyze the benefits of early screening and management. Statistical Analysis Data were expressed as number (%) and compared using Wilcoxon signed-rank test. The two groups (patients with dysphagia vs • Fiber-optic endoscopic evaluation of swallowing (FEES): 3 We performed this procedure along with our speech and
Screening for Oropharyngeal Dysphagia in Stroke: Insufficient Evidence for Guidelines
Dysphagia, 2000
To systematically review and evaluate current peer-reviewed published literature to determine whether there is sufficient evidence to recommend bedside clinical screening guidelines for oropharyngeal dysphagia in adults with stroke. Searching MEDLINE, HealthSTAR and CINAHL were searched to July 1997 for peer-reviewed articles in the English language, using the keywords 'cerebrovascular disorders' and 'deglutition disorders'. In addition, relevant Internet addresses, including the Cochrane Collaboration and the U.S. National Library of Medicine sites, were searched and extensive handsearches of the bibliographies of identified articles were conducted. Relevant journal were also handsearched. Study selection Study designs of evaluations included in the review Accuracy of screening: editorials, review articles and single-patient case studies were ineligible for inclusion in the review. This section of the review included prospective diagnostic case-control studies, and retrospective and prospective diagnostic cohort studies. Patient benefits: only comparative studies were deemed eligible for this section of the review. Non-randomised trials using data from historical controls were included. Specific interventions included in the review Bedside screening tools to assess oropharyngeal dysphagia, which were noninvasive and easily administered, were eligible for inclusion. A range of clinical signs were assessed in the review. These included oral signs, oropharyngeal signs, laryngeal signs and other clinical neuropharyngeal signs. Diagnostic interventions requiring specialised equipment or specialist expertise were not eligible for inclusion in the review. Patient-reported symptoms were excluded. Reference standard test against which the new test was compared Studies that used videofluoroscopy as the reference standard for the diagnosis of dysphagia were eligible for inclusion in the review. Participants included in the review Studies were eligible for the review if they investigated adult patients (greater than 18 years of age) in acute, chronic or rehabilitation settings. Studies of dysphagia owing to other causes were excluded. Outcomes assessed in the review The outcomes of interest in the review were categorised into two groups: outcomes relating to the accuracy of screening and outcomes relating to the benefit to patients who were screened. Accuracy of screening: the outcomes evaluated were sensitivity, specificity and positive likelihood ratios. Where sufficient data to calculate these parameters were not presented, the parameter was excluded from the review. Patient benefits: the outcomes included those relating to health and illness, to functioning and to cost. How were decisions on the relevance of primary studies made?
Ceska A Slovenska Neurologie A Neurochirurgie, 2020
Background: Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established. Results: The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well. Conclusion: The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.
Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review
2021
Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It's well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed. Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method, which is by asking the following four questions: does the patient cough or choke while eating or drinking; whether the patient takes longer than usual to eat; does the patient change the thickness of the food to be able to swallow, and whether the voice turns hoarse after eating or drinking; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method, namely modification of feeding with first pudding, nectar and finally water; 5) Simplified Cough Test Method. The five screening methods for dysphagia above have been tested for sensitivity and specificity, as well as positive and negative predictive values Conclusion: screening is a first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity.
Dysphagia Screening Protocol for Acute Stroke Patient: A Literature Review
2021
Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It’s well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed. Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening perfo...
Predictors of prolonged dysphagia following acute stroke
Journal of Clinical Neuroscience, 2003
Dysphagia following acute stroke frequently necessitates prolonged enteral feeding. There is evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. The aim of this study was to identify predictors of prolonged dysphagia. The subjects were 149 consecutive patients admitted with acute stroke. Clinical findings and imaging results were prospectively collected, and subsequent progress recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (O14 days); or prolonged dysphagia (>14 days). Validity of the water swallow test as a predictor of aspiration pneumonia was confirmed. Significant associations for prolonged dysphagia were seen with stroke severity, dysphasia and lesions of the frontal and insular cortex on brain imaging. These results indicate that it may be possible to predict patients who will develop prolonged significant dysphagia following acute stroke thereby facilitating referral for insertion of PEG at an earlier time point. ª