Summary of the Clinical Practice Guideline

Article Citation

Best Practice Recommendations for Stroke Patients With Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation

Umay, E., Eyigor, S., et al. (2021).
Dysphagia, Epub ahead of print retrieved January 25, 2021 from https://doi.org/10.1007/s00455-020-10218-8.
Go to Article

Sponsoring Body

Turkish Society of Physical Medicine and Rehabilitation (PMR)-Dysphagia Working Group

Article Quality Ratings

Read about Our Rating Process

AGREE Rating

Recommended with Provisos

Article Details

Description

This is a guideline providing consensus-based recommendations on the management of dysphagia in patients with stroke.

Evidence Ratings for This Document

All recommendations were rated by expert group members on a 10-point scale: 0 indicating total disagreement and 10 indicating total agreement. Overall strength of recommendations was determined based on percent agreement between panel (%), median value, and interquartile range (IQR) and categorized as follows:
  • Overall Consensus:  There is overall committee support for recommendation with an agreement rate between 8 and 10 points (≥80%), a median value between 9 and 10 points and an IQR of ≤2 points,
  • Approaching Consensus: There is considerable support for recommendation with an agreement rate in between 8 and 10 points (65–79%), a median value between 8 and 10 points and IQR of ≤3).
  • Overall Divergence: There is significantly divergent views for recommendation with an agreement rate in between 8 and 10 points (<65%), or median value is <8 points or IQR is >3.

Recommendations from This Guideline

What are Recommendations?

Go to Map

Assessment

Stroke patients with dysphagia or at risk for aspiration should receive an instrumental assessment to determine course of swallowing rehabilitation (Approaching Consensus).

Keywords: Swallowing Assessments-Imaging (e.g. FEES/VFSS), Imaging Assessment (Not Specified), Dysphagia, Stroke

Treatment

The following treatments did not have sufficient information regarding their effectiveness and are recommended as third-line treatments for patients with dysphagia post stroke:
  • Biofeedback (Overall Consensus), and
  • Electrical stimulation and biofeedback (Approaching Consensus).

Keywords: Biofeedback, Biofeedback, Electrical Stimulation, Electrical Stimulation, Dysphagia, Stroke

The following treatments have been shown to be somewhat efective and should be considered as second-line treatments for patients with dysphagia post stroke:
  • Swallowing maneuvers (e.g., Mendelson and Masako) (Overall Consensus), 
  • Texture modification (Overall Consensus), 
  • Oral motor strengthening exercises (Approaching Consensus), and 
  • Electrical stimulation (Overall Divergence).

Keywords: Diet Modification, Diet Modification, Electrical Stimulation, Electrical Stimulation, Oral-Motor Treatments, Dysphagia, Postural Techniques/Maneuvers, Oral Motor Treatments (includes Shaker Exercises), Postural Techniques/Maneuvers, Stroke

Swallowing rehabilitation may include a core set of passive and/or active treatments to prevent aspiration. The following treatments have been shown to be effective and should be considered as first-line treatments for patients with dysphagia post stroke:
  • Patient/family education pertaining to dysphagia, its complication and treatment options,
  • Oral hygiene and oral care, and
  • Compensatory and therapeutic methods based on patient’s defined dysphagia problem (dysphagia state and severity),
  • Upright positioning for orally fed patients, 
  • Bolus volume modification,
  • Oral sensory stimulation (Overall Consensus).

Keywords: Diet Modification, Diet Modification, Education/Training (Includes Oral Hygiene), Education/Training (includes Oral Hygiene), Dysphagia, Postural Techniques/Maneuvers, Thermal/Tactile Stimulation, Postural Techniques/Maneuvers, Sensory Stimulation, Stroke

All stroke patients with dysphagia or at risk for aspiration should be included in a swallowing rehabilitation program. Treatment should be individualized and initiated as soon as possible (Overall Consensus).

Keywords: Timing, Timing, Dysphagia, Stroke

Service Delivery

All stroke patients with dysphagia or at risk for aspiration should be included in a swallowing rehabilitation program. Treatment should be individualized and initiated as soon as possible (Overall Consensus).

Keywords: Timing, Timing, Dysphagia, Stroke

Go to Map

Assessment

Stroke patients with dysphagia or at risk for aspiration should receive an instrumental assessment to determine course of swallowing rehabilitation (Approaching Consensus).

Keywords: Swallowing Assessments-Imaging (e.g. FEES/VFSS), Imaging Assessment (Not Specified), Dysphagia, Stroke

Treatment

The following treatments did not have sufficient information regarding their effectiveness and are recommended as third-line treatments for patients with dysphagia post stroke:
  • Biofeedback (Overall Consensus), and
  • Electrical stimulation and biofeedback (Approaching Consensus).

Keywords: Biofeedback, Biofeedback, Electrical Stimulation, Electrical Stimulation, Dysphagia, Stroke

The following treatments have been shown to be somewhat efective and should be considered as second-line treatments for patients with dysphagia post stroke:
  • Swallowing maneuvers (e.g., Mendelson and Masako) (Overall Consensus), 
  • Texture modification (Overall Consensus), 
  • Oral motor strengthening exercises (Approaching Consensus), and 
  • Electrical stimulation (Overall Divergence).

Keywords: Diet Modification, Diet Modification, Electrical Stimulation, Electrical Stimulation, Oral-Motor Treatments, Dysphagia, Postural Techniques/Maneuvers, Oral Motor Treatments (includes Shaker Exercises), Postural Techniques/Maneuvers, Stroke

Swallowing rehabilitation may include a core set of passive and/or active treatments to prevent aspiration. The following treatments have been shown to be effective and should be considered as first-line treatments for patients with dysphagia post stroke:
  • Patient/family education pertaining to dysphagia, its complication and treatment options,
  • Oral hygiene and oral care, and
  • Compensatory and therapeutic methods based on patient’s defined dysphagia problem (dysphagia state and severity),
  • Upright positioning for orally fed patients, 
  • Bolus volume modification,
  • Oral sensory stimulation (Overall Consensus).

Keywords: Diet Modification, Diet Modification, Education/Training (Includes Oral Hygiene), Education/Training (includes Oral Hygiene), Dysphagia, Postural Techniques/Maneuvers, Thermal/Tactile Stimulation, Postural Techniques/Maneuvers, Sensory Stimulation, Stroke

All stroke patients with dysphagia or at risk for aspiration should be included in a swallowing rehabilitation program. Treatment should be individualized and initiated as soon as possible (Overall Consensus).

Keywords: Timing, Timing, Dysphagia, Stroke

Service Delivery

All stroke patients with dysphagia or at risk for aspiration should be included in a swallowing rehabilitation program. Treatment should be individualized and initiated as soon as possible (Overall Consensus).

Keywords: Timing, Timing, Dysphagia, Stroke

Our Partners

About Us

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 218,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.

Read more

Connect with ASHA

Information For


Contact Us

The ASHA Action Center welcomes questions and requests for information from members and non-members.

Available 8:30 a.m.–5:00 p.m. ET
Monday–Friday

E-mail the Action Center
Members: 800-498-2071
Non-Member: 800-638-8255
Read More

Site Help | A–Z Topic Index | Privacy Statement | Terms of Use
© 1997-2022 American Speech-Language-Hearing Association