As April Stroke Awareness month closes, we wanted to bring you some important information regarding stroke victims. Trouble swallowing (dysphagia) is very common after a stroke. It’s undoubtedly a dangerous condition, as it can lead to acute problems such as malnutrition and dehydration. Dysphagia after stroke also makes patients more vulnerable to chest infections like pneumonia.
Stroke Briefly Explained
According to the American Stroke Association, a stroke is a sudden cessation of blood supply to the brain. Currently, stroke is the fifth leading cause of death in the United States. Nearly 800,000 Americans suffer from a stroke every year, and around 140,000 will die from it.
Basically, a stroke occurs when a blood vessel carrying oxygen and nutrients to the brain ruptures or is blocked. So, a portion of the brain doesn’t get the oxygen it needs, leading brain cells to die.
Types of Stroke
- Ischemic Strokes are caused by blood clots blocking an artery.
- Hemorrhagic Strokes are caused by ruptured blood vessels and can also be known as bleeds.
- Transient Ischemic Attacks (TIAs) reference mini-strokes that generally last for only a few minutes.
How Common is Dysphagia After Stroke?
Many patients experience difficulty swallowing after a stroke. About 37% of ischemic stroke patients suffer from it. Additionally, a remarkable 78% of hemorrhagic stroke patients experience dysphagia as well, according to the US National Library of Medicine.
Correspondingly, research shows that:
- 50% of stroke survivors suffer varying degrees of dysphagia symptoms
- 80% of stroke survivors who experience prolonged dysphagia require alternative methods of enteral (tube) feeding
- 49% of stroke patients suffer from malnutrition, while 58% experience dehydration
- Only 45% of patients who experience dysphagia after stroke enjoy eating
Latest Dysphagia Research Highlights the Importance of Bedside Screening
Dysphagia Screening After Stroke
Screening methods vary. According to Marion Bloch’s researchers, “Dysphagia screening may consist of a structured bedside swallow screen administered by nursing staff, bedside swallow evaluation by a speech-language pathologist, videofluoroscopic swallow evaluation, fiber optic endoscopic evaluation of swallowing, or other method approved by local institutional protocol.”
Common modern dysphagia screening protocols include:
- a patient interview or questionnaire
- observation for signs of swallowing dysfunction
- observation at mealtimes
- administration of the 3-oz Water Swallow Test or The Blue Dye Test
- communication of results to the patient, caregivers, and medical professionals involved
The Blue Dye Test vs. Water Swallow Test
The Blue Dye Test
As stated by the American Speech-Language-Hearing Association (ASHA), “The Modified Evans Blue Dye Test (generally referred to as a “blue dye test”) is completed in patients with a tracheotomy by tinting oral feedings blue/green with the intent to identify aspiration in these patients.” Basically, this test can only be given in a strictly clinical setting. Also, it should only be reserved for tracheotomy patients.
But, what is aspiration? Aspiration generally refers to food and fluids ending up in the lungs rather than the stomach. Research shows that dysphagic patients with confirmed aspiration are 11 times more susceptible to pneumonia.
New research at Johns Hopkins has proven, however, that the 3-oz water swallow test is the most effective in detecting dysphagia and aspiration. Therefore, it should be the preferred method of screening.
Based on the findings, the water swallow test accurately detected aspiration when present. Specifically, the research team found that when patients took consecutive sips of more than a tablespoon each, the test accurately ruled out aspiration. When patients could only take sips of one tablespoon or less, the test accurately ruled for aspiration.
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