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

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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?

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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

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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

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