Swallowing and prevention of complications

Abstract

Dysphagia occurs in up to half of patients following a stroke. In most, it is transient with only about 1 in 10 of patients having any swallowing problems at 6 months. Persistent dysphagia may be due to lack of bilateral cerebral hemisphere representation of the oral and pharyngeal musculature involved in swallowing. Thus, the unaffected hemisphere is unable to take over the function of the damaged side. Bedside assessment is not a good predictor of aspiration on videofluoroscopy, but measurement of oxygen saturation may improve this. Nevertheless, clinical detection of dysphagia may be the more powerful predictor of an increased mortality and morbidity, including pneumonia, water depletion and poor nutrition. Dysphagia is also closely related to poor nutrition following stroke, but we do not know whether feeding support will improve outcome. Major trials are on-going.