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Dysphagia

, Volume 19, Issue 1, pp 28–35 | Cite as

Awareness of Dysphagia by Patients Following Stroke Predicts Swallowing Performance

  • Claire Parker
  • Maxine Power
  • Shaheen Hamdy
  • Audrey Bowen
  • Pippa Tyrrell
  • David G. Thompson
Article

Abstract

Patients’ awareness of their disability after stroke represents an important aspect of functional recovery. Our study aimed to assess whether patient awareness of the clinical indicators of dysphagia, used routinely in clinical assessment, related to an appreciation of “a swallowing problem” and how this awareness influenced swallowing performance and outcome in dysphagic stroke patients. Seventy patients were studied 72 h post hemispheric stroke. Patients were screened for dysphagia by clinical assessment, followed by a timed water swallow test to examine swallowing performance. Patient awareness of dysphagia and its significance were determined by detailed question-based assessment. Medical records were examined at three months. Dysphagia was identified in 27 patients, 16 of whom had poor awareness of their dysphagic symptoms. Dysphagic patients with poor awareness drank water more quickly (5 ml/s vs. <1 ml/s, p = 0.03) and took larger volumes per swallow (10 ml vs. 6 ml, p = 0.04) than patients with good awareness. By comparison, neither patients with good awareness or poor awareness perceived they had a swallowing problem. Patients with poor awareness experienced numerically more complications at three months. Stroke patients with good awareness of the clinical indicators of dysphagia modify the way they drink by taking smaller volumes per swallow and drink more slowly than those with poor awareness. Dysphagic stroke patients, regardless of good or poor awareness of the clinical indicators of dysphagia, rarely perceive they have a swallowing problem. These findings may have implications for longer-term outcome, patient compliance, and treatment of dysphagia after stroke.

Keywords

Aspiration Dysphagia Stroke Deglutition Deglutition disorders 

Notes

Acknowledgements

This study was supported by a grant from the North Western Regional Health Authority Biomedical Research Fund. We would also like to thank the Speech and Language Therapy Department of Hope Hospital for supporting this study and Elizabeth Hill for statistical advice. Shaheen Hamdy is an MRC (UK) Clinician Scientist. Maxine Power was an MRC (UK) Clinical Training Fellow. The Stroke Association funded Audrey Bowen and Pippa Tyrrell.

References

  1. 1.
    Smithard, DG, O’Neill, PA, England, R, Park, C, Wyatt, R, Martin, D, Morris, J 1997The natural history of dysphagia following a stroke.Dysphagia12188193PubMedGoogle Scholar
  2. 2.
    Roth, EJ 1991Medical complications encountered in stroke rehabilitation.Phys Med Rehab Clin North Am2563578Google Scholar
  3. 3.
    Smithard, DG, O’Neill, PA, Park, C, Morris, J, Wyatt, R, England, R, Martin, D 1996Complication and outcome after acute stroke. Does dysphagia matter?Stroke2712001204PubMedGoogle Scholar
  4. 4.
    Barer, DH 1989The natural history and functional consequences of dysphagia after hemispheric stroke.J Neurol Neurosurg Psychiatry52236241PubMedGoogle Scholar
  5. 5.
    Mann, G, Hankey, GJ, Cameron, D 1999Swallowing function after stroke prognosis and prognostic factors at 6 months.Stroke30744748PubMedGoogle Scholar
  6. 6.
    Logemann, J 1986Treatment of aspiration related to dysphagia: an overview.Dysphagia13438Google Scholar
  7. 7.
    Ali, GN, Laundl, TM, Wallace, KL, deCarle, DJ, Cook, IJS 1996Influence of cold stimulation on the normal pharyngeal swallow response.Dysphagia1128PubMedGoogle Scholar
  8. 8.
    Elmståhl, S, Bülow, M, Ekberg, O, Petersson, M, Tegner, H 1999Treatment of dysphagia improves nutritional conditions in stroke patients.Dysphagia146166PubMedGoogle Scholar
  9. 9.
    Low, J, Wyles, C, Wilkinson, T, Sainsbury, R 2001The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy.Dysphagia16123127CrossRefPubMedGoogle Scholar
  10. 10.
    Gordon, C, Langton Hewer, R, Wade, D 1987Dysphagia in acute stroke.BMJ295411414PubMedGoogle Scholar
  11. 11.
    Nilsson, H, Ekberg, O, Olsson, R, Hindfelt, B 1998Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients.Dysphagia133238PubMedGoogle Scholar
  12. 12.
    McGlynn, SM, Schacter, DL 1989Unawareness of deficits in neuropsychological syndromes.J Clin Exp Neuropsychol11143205PubMedGoogle Scholar
  13. 13.
    Babinski, MJ 1914Contribution a l’etude des troubles mentaux dans l’hemiplegie organique cerebrate (Anosognosia). [Contribution to the study of mental disturbance in organic cerebral hemiplegia (Anosognosia)].Rev Neurolog12845848Google Scholar
  14. 14.
    Stuss, DT, Benson, DF 1984Neuropsychological studies of the frontal lobes.Psychol Bull95328PubMedGoogle Scholar
  15. 15.
    Buchholz, DW, Bosma, J, Donner, M 1985Adaptation, compensation and decompensation of the pharyngeal swallow.Gastrointest Radiol10235239PubMedGoogle Scholar
  16. 16.
    Wallace, K, Middleton, S, Cook, IJ 2000Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia.Gastroenterology118678687PubMedGoogle Scholar
  17. 17.
    Mahoney, FL, Barthel, DW 1965Functional evaluation: the Barthel index.Maryland State Med J146165Google Scholar
  18. 18.
    Logemann, JA, Veis, S, Colangelo, L 1999A screening procedure for oropharyngeal dysphagia.Dysphagia144451PubMedGoogle Scholar
  19. 19.
    Logemann, JA 1993Manual for the videofluorographic study of swallowing, 2nd ed.Pro-Ed,Austin, TX:Google Scholar
  20. 20.
    Hughes, TAT, Wiles, CM 1996Clinical measurement of swallowing in health and in neurogenic dysphagia.Q J Med89109116Google Scholar
  21. 21.
    Miller, AJ 1982Deglutition.Physiol Rev62129184PubMedGoogle Scholar
  22. 22.
    Hamdy, S, Mikulis, D, Crawley, A, Xue, S, Lau, H, Henry, S, Diamant, NE 1999Cortical activation during human volitional swallowing: an event-related fMRI study.Am J Physiol277G219G225Google Scholar
  23. 23.
    Martin, RE, Sessle, BJ 1993The role of the cerebral cortex in swallowing.Dysphagia8195202PubMedGoogle Scholar
  24. 24.
    Nilsson, H, Ekberg, O, Olsson, R, Hindfelt, B 1996Quantitative aspects of swallowing in an elderly population.Dysphagia11180184PubMedGoogle Scholar
  25. 25.
    Kahrilas, PJ, Shezang, Lin, Chen, J, Logemann, JA 1996Oropharyngeal accommodation to swallow volume.Gastroenterology111297306PubMedGoogle Scholar
  26. 26.
    Dantas, RO, Kern, MK, Massey, BT, Dodds, WJ, Kahrilas, PJ, Brasseur, JG, Cook, IJ, Lang, IM 1990Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing.Am J Physiol258G675G681PubMedGoogle Scholar
  27. 27.
    Logemann, JA, Kahrilas, PJ, Cheng, J, Pauloski, BR, Gibbons, PJ, Rademaker, AW, Lin, S 1992Closure mechanisms of laryngeal vestibule during swallow.Am J Physiol262G338G344PubMedGoogle Scholar
  28. 28.
    Hamdy, S, Aziz, Q, Rothwell, JC, Crone, R, Hughes, DG, Tallis, RC, Thompson, DG 1997Explaining oro-pharyngeal dysphagia after unilateral hemispheric stroke.Lancet350686692PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 2004

Authors and Affiliations

  • Claire Parker
    • 1
  • Maxine Power
    • 2
  • Shaheen Hamdy
    • 2
  • Audrey Bowen
    • 3
  • Pippa Tyrrell
    • 4
  • David G. Thompson
    • 2
  1. 1.Speech and Language Therapy DepartmentHope Hospital, Salford, ManchesterUK
  2. 2.Department of GI SciencesUniversity of Manchester, Hope Hospital, Salford, ManchesterUK
  3. 3.Human Communication and Deafness GroupUniversity of Manchester, Salford, ManchesterUK
  4. 4.Department of Stroke MedicineUniversity of Manchester, Hope Hospital, Salford, ManchesterUK

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