What Is The Post-Stroke Swallowing Disorder?

What Is The Post-Stroke Swallowing Disorder?

What Is The Post-Stroke Swallowing Disorder?

Mar 7, 2024

Post-stroke swallowing disorder is a critical neurological complication that poses a life-threatening risk. While a stroke affects different regions of the brain, post-stroke swallowing disorders are observed in 29-81% of acute stroke patients, depending on the diagnostic criteria, evaluation method, and timing. Although most patients show improvement in swallowing function within the first few weeks after stroke, 11-50% continue to experience swallowing disorders even six months post-stroke. Swallowing disorders after a stroke typically result from a lack of strength or coordination of the oral and pharyngeal muscles. This may manifest as difficulty in initiating the reflex phase of swallowing, following an infarction in the brainstem, bilateral paralysis, or motor programming issues as observed in dyspraxia of swallowing. Swallowing disorders often occur during the oropharyngeal phase of swallowing.

Studies have shown that several factors such as advanced age, female gender, diabetes, hypertension, and atrial fibrillation increase the risk of developing swallowing disorders after a stroke. Swallowing disorders are associated with middle cerebral artery, brain stem infarcts, hemorrhagic stroke, left hemisphere lesions, bilateral hemispheric stroke, previous stroke history, and stroke severity. Additionally, the severity of swallowing disorders may also depend on the size of the lesion.

Swallowing disorders lead to increased morbidity and mortality in patients with acute stroke due to malnutrition, dehydration, and aspiration pneumonia. They also adversely affect the quality of life and psychological well-being of patients, resulting in social isolation and exclusion. To prevent post-stroke pneumonia and reduce the risk of early death, healthcare professionals should screen patients for swallowing disorders before administering oral food, liquid, or medication using a formal swallowing disorder screening test within 24 hours of acute stroke.

Early assessment of swallowing impairment following a stroke is crucial as post-stroke dysphagia is a leading cause of acute stroke deaths. A detailed clinical examination and evaluation of oral motor and laryngeal structure and functions are necessary to diagnose swallowing disorders accurately. Symptoms such as choking, coughing during swallowing, wet sounds after swallowing, delayed initiation of swallowing, uncoordinated chewing, or delayed swallowing may suggest the presence of swallowing disorders. Tools such as water swallow tests or multiple consistency tests can be used for screening, while videofluoroscopic (VFSS) swallowing assessment, fiberoptic endoscopic swallowing assessment (FEES), and electromyography (EMG) are interventional or non-invasive tools used for assessment. The Toronto Bedside Swallowing Screening Test, Gugging Swallowing Screen (GUSS), Mann Assessment of Swallowing Ability (MASA) and its modified form, Barnes Jewish Hospital Stroke and Swallowing Disorder Screening, Simple Swallow Provocation Test, and 3 oz water test (3 oz Water Test) are non-invasive tools recommended for evaluating swallowing disorders in stroke patients.

GFF/ESO recommends the evaluation of swallowing disorders in stroke patients with severe facial palsy, severe dysarthria, severe aphasia, or general severe neurological impairment, who fail to screen for swallowing disorders, and states that it should be performed as soon as possible.


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