Skip to main content
SpringerLink
Log in

Awareness of Dysphagia by Patients Following Stroke Predicts Swallowing Performance

  • Published:
Dysphagia Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. DG Smithard PA O’Neill R England C Park R Wyatt D Martin J Morris (1997) ArticleTitleThe natural history of dysphagia following a stroke. Dysphagia 12 188–193 Occurrence Handle1:STN:280:ByiH2c%2FntlA%3D Occurrence Handle9294937

    CAS  PubMed  Google Scholar 

  2. EJ Roth (1991) ArticleTitleMedical complications encountered in stroke rehabilitation. Phys Med Rehab Clin North Am 2 563–578

    Google Scholar 

  3. DG Smithard PA O’Neill C Park J Morris R Wyatt R England D Martin (1996) ArticleTitleComplication and outcome after acute stroke. Does dysphagia matter? Stroke 27 1200–1204 Occurrence Handle1:STN:280:BymB1M%2FgtFM%3D Occurrence Handle8685928

    CAS  PubMed  Google Scholar 

  4. DH Barer (1989) ArticleTitleThe natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 52 236–241 Occurrence Handle1:STN:280:BiaC1MbgtVw%3D Occurrence Handle2564884

    CAS  PubMed  Google Scholar 

  5. G Mann GJ Hankey D Cameron (1999) ArticleTitleSwallowing function after stroke prognosis and prognostic factors at 6 months. Stroke 30 744–748 Occurrence Handle1:STN:280:DyaK1M3gsFehtw%3D%3D Occurrence Handle10187872

    CAS  PubMed  Google Scholar 

  6. J Logemann (1986) ArticleTitleTreatment of aspiration related to dysphagia: an overview. Dysphagia 1 34–38

    Google Scholar 

  7. GN Ali TM Laundl KL Wallace DJ deCarle IJS Cook (1996) ArticleTitleInfluence of cold stimulation on the normal pharyngeal swallow response. Dysphagia 11 2–8 Occurrence Handle1:STN:280:BymC2cfhvVU%3D Occurrence Handle8556873

    CAS  PubMed  Google Scholar 

  8. S Elmståhl M Bülow O Ekberg M Petersson H Tegner (1999) ArticleTitleTreatment of dysphagia improves nutritional conditions in stroke patients. Dysphagia 14 61–66 Occurrence Handle10028034

    PubMed  Google Scholar 

  9. J Low C Wyles T Wilkinson R Sainsbury (2001) ArticleTitleThe effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy. Dysphagia 16 123–127 Occurrence Handle10.1007/s004550011002 Occurrence Handle1:STN:280:DC%2BD3MzlsFWmtw%3D%3D Occurrence Handle11305222

    Article  CAS  PubMed  Google Scholar 

  10. C Gordon R Langton Hewer D Wade (1987) ArticleTitleDysphagia in acute stroke. BMJ 295 411–414 Occurrence Handle1:STN:280:BieD3c7ksFE%3D Occurrence Handle3115478

    CAS  PubMed  Google Scholar 

  11. H Nilsson O Ekberg R Olsson B Hindfelt (1998) ArticleTitleDysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients. Dysphagia 13 32–38 Occurrence Handle1:STN:280:DyaK1c%2FlsVWksg%3D%3D Occurrence Handle9391228

    CAS  PubMed  Google Scholar 

  12. SM McGlynn DL Schacter (1989) ArticleTitleUnawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol 11 143–205 Occurrence Handle1:STN:280:BiaC2srjsFA%3D Occurrence Handle2647781

    CAS  PubMed  Google Scholar 

  13. MJ Babinski (1914) ArticleTitleContribution 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 Neurolog 12 845–848

    Google Scholar 

  14. DT Stuss DF Benson (1984) ArticleTitleNeuropsychological studies of the frontal lobes. Psychol Bull 95 IssueID1 3–28 Occurrence Handle1:STN:280:BimD2czhslE%3D Occurrence Handle6544432

    CAS  PubMed  Google Scholar 

  15. DW Buchholz J Bosma M Donner (1985) ArticleTitleAdaptation, compensation and decompensation of the pharyngeal swallow. Gastrointest Radiol 10 235–239 Occurrence Handle1:STN:280:BiqB1cnht1I%3D Occurrence Handle4029539

    CAS  PubMed  Google Scholar 

  16. K Wallace S Middleton IJ Cook (2000) ArticleTitleDevelopment and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology 118 678–687 Occurrence Handle1:STN:280:DC%2BD3c3gtVehtg%3D%3D Occurrence Handle10734019

    CAS  PubMed  Google Scholar 

  17. FL Mahoney DW Barthel (1965) ArticleTitleFunctional evaluation: the Barthel index. Maryland State Med J 14 61–65 Occurrence Handle1:STN:280:CCqD28zks1I%3D

    CAS  Google Scholar 

  18. JA Logemann S Veis L Colangelo (1999) ArticleTitleA screening procedure for oropharyngeal dysphagia. Dysphagia 14 44–51 Occurrence Handle1:STN:280:DyaK1M%2FkslCmsw%3D%3D Occurrence Handle9828274

    CAS  PubMed  Google Scholar 

  19. JA Logemann (1993) Manual for the videofluorographic study of swallowing, 2nd ed. Pro-Ed, Austin, TX:

    Google Scholar 

  20. TAT Hughes CM Wiles (1996) ArticleTitleClinical measurement of swallowing in health and in neurogenic dysphagia. Q J Med 89 IssueID2 109–116 Occurrence Handle1:STN:280:BymA3cnls10%3D

    CAS  Google Scholar 

  21. AJ Miller (1982) ArticleTitleDeglutition. Physiol Rev 62 IssueID1 129–184 Occurrence Handle1:STN:280:Bi2C3cnis1E%3D Occurrence Handle7034008

    CAS  PubMed  Google Scholar 

  22. S Hamdy D Mikulis A Crawley S Xue H Lau S Henry NE Diamant (1999) ArticleTitleCortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol 277 G219–G225 Occurrence Handle1:CAS:528:DyaK1MXkslKnsbs%3D

    CAS  Google Scholar 

  23. RE Martin BJ Sessle (1993) ArticleTitleThe role of the cerebral cortex in swallowing. Dysphagia 8 195–202 Occurrence Handle1:STN:280:ByyA28rjtVU%3D Occurrence Handle8359039

    CAS  PubMed  Google Scholar 

  24. H Nilsson O Ekberg R Olsson B Hindfelt (1996) ArticleTitleQuantitative aspects of swallowing in an elderly population. Dysphagia 11 180–184 Occurrence Handle8755461

    PubMed  Google Scholar 

  25. PJ Kahrilas Lin Shezang J Chen JA Logemann (1996) ArticleTitleOropharyngeal accommodation to swallow volume. Gastroenterology 111 297–306 Occurrence Handle1:STN:280:BymA3crgvFM%3D Occurrence Handle8690194

    CAS  PubMed  Google Scholar 

  26. RO Dantas MK Kern BT Massey WJ Dodds PJ Kahrilas JG Brasseur IJ Cook IM Lang (1990) ArticleTitleEffect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol 258 G675–G681 Occurrence Handle1:STN:280:By%2BB2c%2FksVI%3D Occurrence Handle2333995

    CAS  PubMed  Google Scholar 

  27. JA Logemann PJ Kahrilas J Cheng BR Pauloski PJ Gibbons AW Rademaker S Lin (1992) ArticleTitleClosure mechanisms of laryngeal vestibule during swallow. Am J Physiol 262 G338–G344 Occurrence Handle1:STN:280:By2C2s%2Fpt1E%3D Occurrence Handle1539666

    CAS  PubMed  Google Scholar 

  28. S Hamdy Q Aziz JC Rothwell R Crone DG Hughes RC Tallis DG Thompson (1997) ArticleTitleExplaining oro-pharyngeal dysphagia after unilateral hemispheric stroke. Lancet 350 686–692 Occurrence Handle1:STN:280:ByiH3sjjs10%3D Occurrence Handle9291902

    CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Speech and Language Therapy Department, Hope Hospital, Salford, Manchester, UK

    Claire Parker MPhil

  2. Department of GI Sciences, University of Manchester, Hope Hospital, Salford, Manchester, UK

    Maxine Power PhD, Shaheen Hamdy PhD & David G. Thompson PhD

  3. Human Communication and Deafness Group, University of Manchester, Salford, Manchester, UK

    Audrey Bowen PhD

  4. Department of Stroke Medicine, University of Manchester, Hope Hospital, Salford, Manchester, UK

    Pippa Tyrrell PhD

Authors
  1. Claire Parker MPhil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxine Power PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaheen Hamdy PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Audrey Bowen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pippa Tyrrell PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David G. Thompson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David G. Thompson PhD.

Appendix 1: Swallowing Questionnaire

Appendix 1: Swallowing Questionnaire

The detailed question based assessment used on all dysphagic patients following clinical assessment of swallowing to determine which patients had good or poor awareness of their swallowing

Figure 3
figure 3

.

Full size image

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parker, C., Power, M., Hamdy, S. et al. Awareness of Dysphagia by Patients Following Stroke Predicts Swallowing Performance . Dysphagia 19, 28–35 (2004). https://doi.org/10.1007/s00455-003-0032-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-003-0032-8

Keywords

Search

Navigation