Accurate assessment, precise treatment, and improved dysphagia after stroke

Accurate assessment, precise treatment, and improved dysphagia after stroke

Swallowing is the result of a series of complex, highly coordinated muscle movements. The swallowing center within the medulla manages and coordinates the entire process of swallowing.

Post-stroke often leads to swallowing dysfunction, which seriously affects the quality of life of patients, can lead to a variety of complications such as aspiration pneumonia, dehydration, malnutrition, and even life-threatening!

 Come across these condition as stated below??

• Do not like solid foods and have difficulty in eating;

• Spend long time on eating , usually more than 30 minutes;

• Easily  drool

• Easily choking and coughing during meals

• Unable to drink water using cup continuously;

Suggestion: Come to the rehabilitation department to do a systematic swallowing test!

Assessment of dysphagia:

Step 1: Screening

- Early screening of people at risk of dysphagia (EAT-10; water swallowing test)

Step 2: Assess risk

-- Evaluation of oral and throat disorders (V-VST, etc.)

Step 3: clinical evaluation

-- Assessment and Development & Adjustment Interventions (SOAP)

Step 4: Instrument Evaluation

-- Combining the objective physiological assessment of the instrument (VFSS and FEES)

The patient was asked to perform water swallowing test to screen for suspected swallowing disorder. When the condition permits, the patient is sent to the angiography room for swallowing angiography further evaluation and to confirm the diagnosis.Then, comprehensive treatment is given. So, patients have comprehensive, accurate, advanced assessment and treatment!

Accurate evaluation · Precise Treatment

Case study

Typical case sharing -

A patient,  in the recovery process of cerebral infarction , speech dysarthria, dysphagia, moderate cognitive impairment.

Chief Complaint: Coughing while drinking water associate with the right limb weakness

Note: The animation is performed on the patient for swallowing angiography evaluation↑

In sitting position, the patient will be given a mixture sputum of 1, 2, and 3 with different consistency. The contrast video showed that the patient's head was poorly controlled, the oral control was poor, the food leaked from the oral cavity, the delivery was poor, and the swallowing was barely acceptable. There was no nasal reflux but there was a little residual in the epiglottis. After repeated swallowing, it could be removed. A small amount of aspiration, a lack of cough reflex, and poor coughing were observed.

Conclusion: Patients with abnormal swallowing function, especially in the oral cavity, the pharyngeal muscles open normally, invisible aspiration, can not handle food with higher viscosity and liquid-typed food. A safe amount is 5ml.

After stroke, the patient has an uncoordinated breathing movement, which causes the patient to inhale during swallowing, which may cause serious consequences such as coughing or aspiration, and even can cause aspiration pneumonia.

The mechanism of dysphagia after stroke is closely related to the damage of the central nervous system of swallowing-related muscles, resulting in decreased swallowing muscle strength or inconsistent movement, insufficient oral or pharyngeal pressure, difficulty in forming and pushing of bolus, and inadequate laryngeal elevation. .

Based on all of the patient's assessments and their own circumstances, the therapist develops a complete and detailed treatment plan that is regularly evaluated during the treatment process.

Routine rehabilitation training

Our treatment includes oral and facial training, respiratory training, airway protection training, indirect training, food preparation and eating guidance training for different traits, VitalStim electrical stimulation therapy, transcranial direct current, transcranial magnetic and so on.

After active treatment, patients have great improvement:

From complete nasal feeding to nowadays, it is possible to actively eat honey-like foods and pudding-like foods, with a mouthful of less than 5ml; patients can utter simple word such as  "ah" and "no" , the cognitive level has also improved significantly.