Research indicates that there is a high incidence of dysphagia after stroke and its episodic consequences are well documented for their detrimental nutritional and health effects.1 Emerging evidence also confirms that early detection of dysphagic symptoms in stroke patients can help to reduce the severity of the disorder, shorten the length of hospital stays, and help dysphagic stroke patients enjoy a higher quality of life.2 Here are additional facts regarding dysphagia in relation to stroke patients.
1. Dysphagia affects a majority of stroke patients.
Dysphagia is a common occurrence among stroke victims. In fact, the swallowing disorder may occur in up to 65 percent of stroke patients.3
2. Oropharyngeal dysphagia is most common in stroke patients.
While esophageal dysphagia is most common in geriatric patients, oropharyngeal dysphagia is most prevalent in stroke patients. This swallowing disorder can be classified as an inability to move food or liquid from the mouth to the upper part of the esophagus.4
3. There are a multitude of Oropharyngeal dysphagia symptoms.
These symptoms include:
- Difficulty initiating the swallow
- Choking when food gets stuck
- Coughing or gagging while swallowing
- Nasal regurgitation (liquid coming out of the nose)
- Food getting caught in the lungs
- Inability to ingest enough food or liquid, causing weight loss
- Weak voice
- Poor tongue control
- Loss of gag reflex5
4. Oropharyngeal dysphagia is often confused with other oral maladies.
Dysphagia in stroke patients is often confused with:
- Odynophagia: painful swallowing
- Globus: the constant feeling of a lump in the throat
Obviously, the treatment of these maladies is distinctly different than dysphagia therapies and should be addressed accordingly.6
5. Dysphagia greatly increases risks of negative health effects.
Stroke patients experiencing dysphagia are seven times more likely to experience choking episodes, aspiration pneumonia, dehydration and malnutrition. Left undiagnosed and/or untreated, these episodes may result in permanent health impairment or fatality.7
6. Dysphagia diagnostic methods have proven effective.
Two methods are at the forefront of dysphagic diagnoses in stroke patients:
- Videofluroscopy (VFS), also known as modified barium swallow, is generally perceived as the “gold standard” for swallowing assessments in stroke patients and entails the administration of radio‐opaque barium liquid with moving images captured in the lateral view of the mouth and throat.
- Fibreoptic endoscoptic evaluation of swallowing (FEES) is a radiation-free alternative to VFS and entails the placement of a nasendoscope to the level of the uvula or soft palate to give a view of the hypopharynx and larynx.8
7. Compensatory strategies can have positive results with dysphagic stroke patients.
Methods for dysphagic adaptation include the following:
- Modifying the consistency of food and fluids supplied to dysphagia patients has proven effective in managing the swallowing disorder.
- The use of physical adaptations while eating, such as a chin tuck when swallowing, head turn or the Mendelsohn Maneuver (an exercise to improve the upward and forward movement of the voice box to prompt swallowing), have yielded positive results in many stroke patients.
- In severe dysphagic cases, a feeding tube may be necessary to provide adequate nutrition and hydration when other compensatory methods fail.9
8. Rehabilitative strategies are possible is some dysphagic stroke patients.
Most evidence indicates that exercises focused on strengthening the opening of the upper oesophageal sphincter have proven effective in stroke patients. These exercises that reinforce the action of the suprahyoid muscles have been proven to increase swallowing capacity in some patients while consequently reducing post‐swallow pharyngeal residue.10
9. Early detection is critical to dysphagia treatment efficacy.
There is emerging evidence that early detection of dysphagia in patients with acute stroke helps to minimize not only the complications listed above but also reduces length of hospital stay and need for comprehensive rehabilitation.11
Understanding pertinent dysphagic data is of ongoing importance in helping stroke patients to address and overcome swallowing challenges. Staying up to date with timely research and issues will be of benefit for both physicians, health care professionals, and caretakers – and the patients they serve.