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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study was undertaken to evaluate the progress of a group of dysphagic stroke patients for whom a dental prosthesis the Palatal Training Appliance (PTA), was used in the active rehabilitation of the swallowing mechanism. Patients selected were those who had sustained a stroke uncomplicated by other neurological illness, during one 12-month period, and whose dysphagia caused anxiety to the medical staff in the hospital ward. Thirty severely dysphagic stroke patients satisfied these criteria. The study recorded the duration and type of supplementary feeding required during hospitalization. Thirteen patients had evidence of aspiration before the PTA was fitted and 5 afterwards. Seven patients died, but only 1 was recorded as having a febrile illness which may have contributed to the death. At discharge, which averaged 10 weeks after admission, 22 of the 23 survivors were taking an adequate oral diet. It was also noted that almost half of the patients who wore dentures before the cerebrovascular event were unable to control them afterwards, adding to their neurological swallowing difficulties. The fitting of a PTA and correction of unstable dentures appeared to help both motivation and function. The results show an improvement in the rehabilitation of oral feeding compared with previous reports by other authors, who did not use the dental appliance. There did not appear to be any medical contraindication to its use.
Dysphagia 1995
PMID:Dysphagia following strokes: clinical observations of swallowing rehabilitation employing palatal training appliances. 785 30

Little objective documentation is available regarding the efficacy of therapies for oropharyngeal dysphagia. Information specifying efficacy of treatment for chronic dysphagic conditions is almost nonexistent. This report describes a direct therapy program for chronic neurogenic dysphagia resulting from brainstem stroke, and provides information on immediate and long-term clinical outcome. Changes in swallowing physiology reflect goals of therapy. Long-term follow-up shows that functional benefits are long lasting without related health complications.
Dysphagia 1995
PMID:A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke. 785 37

Increasing international recognition of the high incidence of oropharyngeal dysphagia has incited Speech and Language Therapists to establish a service for the management of this life-threatening disorder. This study evaluates the first such Irish service instigated in St. James's Hospital four years ago. Retrospective analysis of Speech and Language Therapy departmental records for a twelve month period examined incidence of referral for dysphagia, subsequent clinical and objective assessment findings and management recommendations. A referral rate of 52% emerged with a mean of 74 years. CVA was found to be the commonest etiology. Therapeutic intervention was implemented with 68% of dysphagic subjects considered suitable candidates and improvement evidenced in 78% of treated cases. These results highlight the prevalence of oropharyngeal dysphagia in a neurologically impaired Irish adult population and the efficacy of a dysphagia service in its management, while categorically stating the need for such service provision nationwide.
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PMID:Oropharyngeal dysphagia--the need for effective management. 786 Feb 62

The management of dysphagia presents a major problem in the comprehensive rehabilitation of stroke and head injury patients. Dysphagia is a disorder of the swallowing process. Oral dysphagia refers to abnormalities in the oral phase of the swallowing mechanism. The oral phase of the swallowing mechanism is important for the proper triggering of the swallowing reflex. Current techniques in oral dysphagia rehabilitation include oro-motor exercises using tongue depressors and mouth-care swabs. There is thus a need for a better therapeutic method for oral dysphagia. The purpose of this paper is to report the development of audio-visual biofeedback devices for treating oral dysphagia. Portable biofeedback devices rendering feedback of biomechanical parameters characterizing the oral phase were developed and evaluated in preliminary clinical trials. A patient progress index (PPI) was developed and used to quantify the overall patient progress. The devices demonstrated good patient acceptability.
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PMID:Design and development of portable biofeedback systems for use in oral dysphagia rehabilitation. 795 83

Enteral nutrition has many advantages over parenteral nutrition and is being increasingly used. Percutaneous endoscopic gastrostomy is performed under local anaesthesia by means of a gastroscope inserted for 15-20 minutes. From January 1993 til January 1994 we performed ten percutaneous endoscopic gastrostomies in patients suffering mainly from stroke and dysphagia. The article includes a description of the method and the results. The mean application time for the gastrostomies was 67.9 days (14-238 days). No serious complication was observed, two local wound infections were noted. It is concluded that percutaneous endoscopic gastrostomy is a safe and efficient method for enteral nutrition. The method seems to have few complications, is cheap and is simple to perform.
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PMID:[Percutaneous endoscopic gastrostomy. Experiences with the first 10 cases in a medical department]. 799 90

The objective of this study was to validate a dysphagia screening test to identify patients in the rehabilitation phase post stroke at risk for pneumonia, recurrent upper airway obstruction, and death. The setting was an inpatient stroke rehabilitation unit. One hundred thirty-nine consecutive patients met the following criteria: stroke confirmed by clinical history and neurological exam with compatible computed tomography (CT) or magnetic resonance imaging (MRI) scan; ages 20 to 90 years inclusive; and no known history of significant oral or pharyngeal anomaly. The main outcome measures were pneumonia, recurrent upper airway obstruction, and death. The Burke Dysphagia Screening Test (BDST) identified 11 of 12 patients who subsequently developed pneumonia, recurrent upper airway obstruction, or death (Fisher's exact test: p = .03). The relative risk for the occurrence of any of these complications was 7.65 times greater for those failing versus passing the BDST. The BDST identified 9 of 9 patients who developed pneumonia (Fisher's exact test: p = .01). We concluded that the BDST is of value in identifying patients in the rehabilitation phase poststroke at risk for pneumonia, recurrent upper airway obstruction, and death.
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PMID:The Burke dysphagia screening test: validation of its use in patients with stroke. 763 37

Over the period 1 April 1990 to 31 December 1992, a total of 179 PEG procedures were performed on 161 elderly patients, mean age 79 years (range 53-99). In most (141) patients, the indication was neurological dysphagia (usually stroke), but in 20 the tube was inserted to attain adequate nutritional support. Thirty-day fatality was 20% overall, but in those who underwent PEG only for nutritional support, survival was poor--only 20% at 30 days. Almost all deaths were a result of progression of the original illness. Only one procedure-related death occurred. Fifty-six complicating episodes occurred in 20 (12%) patients, the majority being minor. The commonest adverse event was PEG site infection. PEG is a useful and in general well tolerated procedure in geriatric practice, but careful patient selection is essential; in particular its use as a nutritional adjunct in frail patients needs careful evaluation.
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PMID:The use of percutaneous endoscopic gastrostomy (PEG) in 161 consecutive elderly patients. 802 28

Of all strokes 75% occur in people over age 65, and the incidence of stroke rises with age. Because swallowing problems often result, the elderly stroke patient is at risk for dysphagia and its complications. Acute and chronic swallowing problems are associated with many complications including dehydration, malnutrition, aspiration, pneumonitis, depression and even death. These complications make swallowing problems in the aged stroke patient an important focus for nursing attention. Nurses must be aware of the complexity of normal swallowing mechanisms, knowledgeable about the aged stroke patient's risk for dysphagia, aware of the importance of early detection and treatment of dysphagia and confident about their role in dysphagia assessment and treatment regimen. This information can be used in the assessment, treatment and rehabilitation of the elderly dysphagic stroke patient.
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PMID:Dysphagia in the elderly stroke patient. 807 79

To assess the incidence of lung aspiration in acute stroke, and attempt to identify factors which render such patients at risk of aspiration, consecutive patients admitted to hospital within 24 h of their first symptomatic stroke were studied prospectively. Sixty patients who were conscious, and who did not have any preceding neurological or other cause of dysphagia, were assessed clinically and underwent a bedside water-swallowing test and videofluoroscopy within 72 h of stroke. Twenty-five patients (42%) were seen to aspirate at videofluoroscopy; of these 20% did not have overt dysphagia as detected by a simple water-swallowing test. Factors found to be significantly associated with aspiration were reduced pharyngeal sensation, dysphagia and stroke severity. Aspiration is common in the early period following acute stroke; disordered pharyngeal sensation is an important concomitant of this and should be carefully tested in each patient admitted with acute stroke.
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PMID:Aspiration in acute stroke: a clinical study with videofluoroscopy. 810 39

This retrospective study was undertaken to review aspiration documented by videofluoroscopic modified barium swallow (VMBS) examination in a group of patients admitted to a stroke rehabilitation unit. Forty-two of 54 patients tested demonstrated evidence of aspiration of thin liquids on VMBS performed an average of over 5 weeks following the onset of stroke. However, only patients in whom there was clinical concern of aspiration (54 of 255 stroke patients admitted to the rehab unit) were tested with VMBS evaluation. With this limitation in mind, aspiration was demonstrated in at least 9.9% of all unilateral right hemispheric patients, 12.1% of unilateral left hemispheric, 24% of bilateral hemispheric, and 39.5% of brainstem stroke patients. Of the 42 patients in whom aspiration of thin liquids was demonstrated, 31 underwent repeat VMBS studies an average of 6 weeks after the initial VMBS. 7 of these 31 (22.6%) no longer showed aspiration on VMBS. Eighteen of the 42 patients (43%) clinically stopped aspirating over this 6-week period.
Dysphagia 1994
PMID:Prevalence and recovery of aspiration poststroke: a retrospective analysis. 813 23


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