Original Article
Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit

https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009Get rights and content

Objective

We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients.

Methods

In all, 151 consecutive inpatients with recent ischemic or hemorrhagic stroke were enrolled.

Results

Dysphagia was clinically diagnosed in 62 of 151 patients (41%). A total of 49 patients (79% of clinically dysphagic patients) underwent VFS. Six patients clinically suggested to be dysphagic had a normal VFS finding. The correlation between clinical and VFS diagnosis of dysphagia was significant (r = 0.6505). Penetrations and aspirations were observed, respectively, in 42.8% and 26.5% of patients with dysphagia, with 12.2% classified as silent. Lower respiratory tract infections were observed in 5.9%, more frequently in patients with dysphagia (30%). Dysphagia was not influenced by type of stroke. Cortical stroke of nondominant side was associated with dysphagia (P = .0322) and subcortical nondominant stroke showed a reduced frequency of dysphagia (P = .0008). Previous cerebrovascular disease resulted associated to dysphagia (P = .0399). Patients with dysphagia had significantly lower functional independence measurement (FIM) and level of cognitive functioning on admission and lower FIM on discharge, longer hospital stay, and more frequent malnutrition, and they were more frequently aphasic and dysarthric. Percutaneous endoscopic gastrostomy was used in 18 of 151 patients (11.9%) (41.8% of patients with VFS-proved dysphagia).

Conclusions

Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.

Section snippets

Methods

In all, 151 consecutive inpatients admitted to our neurorehabilitation unit between January 2005 and December 2006 with diagnosis of previous ischemic or hemorrhagic stroke were enrolled in this study. All patients were transferred to the neurorehabilitation unit after the acute phase, with a mean length of stay on intensive care unit of 13 days (range 6-21).

Patients with a history of head and neck damage, history of neurologic disease other than cerebrovascular disorders, or current dysphagia

Results

The patients were admitted with a mean LCF of 6.31 (range 3-8) and FIM of 45.9 (range 18-106). Mean FIM at discharge was 59.6 (range 18-129), with a mean increment of 13.7. The mean length of stay on neurorehabilitation unit was 29.9 days (range 6-93).

Imaging techniques demonstrated no previous cerebrovascular disease in 17 of 151 patients, diffuse cerebrovascular disease in 110 of 151, and a previous stroke in 24 of 151. The prevalence of lesion location of the recent stroke is reported in

Discussion

Dysphagia is a common complication after stroke, but its prevalence is widely discrepant in the various studies, ranging between 29%1 and 81%.2, 3 The frequency of dysphagia in rehabilitation studies ranges widely between 25%26 and 81%.2 These prevalences are probably dependent on which method is used for the diagnosis, the time from stroke, and the severity of stroke in the case study.

The results of this study have been derived from a hospital-referred cohort of consecutive patients with

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