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      A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia

      research-article
      , PhD, OT 1 , , PhD, OT 2 , *
      Journal of Physical Therapy Science
      The Society of Physical Therapy Science
      Dysphagia, Oral intake, Swallowing Function Test

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          Abstract

          [Purpose] This study was conducted to compare the swallowing function and quality of life (QOL) in stroke patients with dysphagia by oral intake level. [Subjects and Methods] Seventy-nine stroke patients with dysphagia were enrolled. All subjects were evaluated by using the Swallowing Function Test (SFT) and the Swallowing Quality of Life (SWAL-QOL) questionnaire. The subjects were divided into two group based on the SFT score: oral intake (OI) and non-oral intake (NOI) groups. The SFT and SWAL-QOL scores were then compared between the groups. [Results] There were significant differences in items in the SFT, except for the respiratory item, between the OI group and the NOI group. There were significant differences in all items on the SWAL-QOL, except for the sleep item, between the OI group and the NOI group. [Conclusion] Oral intake was positively associated the swallowing function and QOL in stroke patients with dysphagia. Safe intervention using oral intake treatments during dysphagia rehabilitation may have a positive effect on the patients’ swallowing function and QOL.

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          Most cited references13

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          Dysphagia following Stroke

          Background: Dysphagia is common after stroke. We aimed to study the prognosis of dysphagia (assessed clinically) over the first 3 months after acute stroke and to determine whether specific neurovascular-anatomical sites were associated with swallowing dysfunction. Methods: We prospectively examined consecutive patients with acute first-ever stroke. The assessment of dysphagia was made using standardized clinical methods. The arterial territories involved were determined on CT/MRI. All patients were followed up for 3 months. Results: 34.7% of 406 patients had dysphagia. Dysphagia was more frequent in patients with hemorrhagic stroke (31/63 vs. 110/343; p = 0.01). In patients with ischemic stroke, the involvement of the arterial territory of the total middle cerebral artery was more frequently associated with dysphagia (28.2 vs. 2.2%; p < 0.0001). Multivariate analysis revealed that stroke mortality and disability were independently associated with dysphagia (p < 0.0001). Conclusions: The frequency of dysphagia was relatively high. Regarding anatomical-clinical correlation, the most important factor was the size rather than the location of the lesion. Dysphagia assessed clinically was a significant variable predicting death and disability at 90 days.
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            Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.

            Dysphagia may predispose stroke patients toward undernutrition and hydration. These comorbidities increase patient risks for reduced functional outcome and short-term mortality. Despite this impact, available information on relationships among dysphagia, nutrition, and hydration status in acute stroke is limited and conflicted. This study evaluated nutrition and hydration status in ischemic stroke patients with versus without clinically significant dysphagia at admission and at discharge from acute care. Sixty-seven patients admitted to the stroke unit in a tertiary-care hospital provided data for this study. On the day of hospital admission and upon discharge or at 7 days post admission, serum biochemical measures were obtained for nutrition (prealbumin) and hydration status (BUN/Cr). Clinical evaluation for dysphagia, nutrition status, and stroke severity were completed an average of 1.4 days following hospital admission. Dysphagia was identified in 37 % of the cohort. At admission 32 % of patients demonstrated malnutrition based on prealbumin levels and 53 % demonstrated evidence of dehydration based on BUN/Cr levels. No differences in nutrition status were attributed to dysphagia. Patients with dysphagia demonstrated significantly higher BUN/Cr levels (greater dehydration) than patients without dysphagia at admission and at discharge. Dehydration at both admission and discharge was associated with dysphagia, clinical nutrition status, and stroke severity. Results of this study support prior results indicating that dysphagia is not associated with poor nutrition status during the first week post stroke. Dehydration status is associated with dysphagia during this period. The results have implications for future confirmatory research and for clinical management of dysphagia in the acute stroke period.
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              Swallowing disorders.

              The oropharyngeal swallow mechanism is comprised of several behaviours that change systematically or occur randomly. The systematic changes are dependent on the bolus characteristics (i.e. volume and viscosity) and voluntary control. An oropharyngeal swallow is rapid (less than 2 s), and videofluoroscopy is required to determine which muscles or nerves are damaged in dysphagic patients. Once the specific problem has been identified, a treatment plan can be designed. Various categories of treatment are available, including behavioural procedures such as changes in head postures, heightening sensory input prior to the swallow, voluntary manoeuvres, exercise programmes, medications and surgical procedures. A swallowing specialist, usually a speech-language pathologist, identifies and assesses optimal treatments and works with the patient to improve swallowing patterns in order to return the patient to safe and efficient oral intake. This chapter describes these approaches.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                15 September 2017
                September 2017
                : 29
                : 9
                : 1552-1554
                Affiliations
                [1) ] Department of Occupational Therapy, Wonkwang University, Republic of Korea
                [2) ] Department of Occupational Therapy, Konyang University: 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-832, Republic of Korea
                Author notes
                [* ]Corresponding author. Doo Han Yoo (E-mail: glovia@ 123456konyang.ac.kr )
                Article
                jpts-2017-225
                10.1589/jpts.29.1552
                5599819
                28931986
                fa088fb0-94f3-4a68-9928-6396a4ad3532
                2017©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/ )

                History
                : 26 April 2017
                : 05 June 2017
                Categories
                Original Article

                dysphagia,oral intake,swallowing function test
                dysphagia, oral intake, swallowing function test

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