Dysphagia Screening for Stroke Survivors

A disorder of swallowing, called dysphagia, affects up to 78% of stroke survivors and can lead to health complications such as: aspiration pneumonia, lung infections, malnutrition, and dehydration (1,2). Improved rates of detection of dysphagia and earlier initiation of dysphagia treatment could significantly decrease mortality rates and post CVA hospitalizations for stroke survivors.

The gold standard for identification of dysphagia is the Video Fluoroscopy Swallow Study (VFSS), where the patient consumes foods and/or liquids which have barium mixed into them so that it may be visualized by video x-ray as it passes through the oral and the pharyngeal phases of the swallow. However, this type of swallow test is very expensive, exposes the patient to radiation, and usually is only performed in a hospital. The Video Fluoroscopy Swallow Studies are not routinely given to every stroke patient due to the disadvantages mentioned above.   Having screening tools which are reliable, less expensive, less potentially harmful, and more readily accessible methods of detecting dysphagia, which can be quickly administered to every stroke patient is important. Consistent use of formal dysphagia screening tools correlates to significantly reduced risk of pneumonia for stroke survivors (4,5).

A study was conducted by Jeff Edmiaston et al., and was published in 2013 (3). The purpose of the study was to investigate the accuracy of the Barnes-Jewish-Hospital-Stroke Dysphagia Screen (BJH-SDS) as compared to Video Fluoroscopy Swallow Study (VFSS) with the same acute stroke patients. Funding was provided for this study by grants from the Barnes-Jewish Hospital Foundation and the National Institute of Health. 

In the study, 225 acute stroke patients were given the BJH-SDS at bedside by a nurse and then were given the VFSS by a speech language pathologist who did not know the results of the BJH-SDS. They assessed the sensitivity of the BJH-SDS as compared to the VFSS for the detection of dysphagia and aspiration. They found the sensitivity for detecting dysphagia was 94% and the sensitivity for detecting aspiration was 95%. The study authors concluded, "The BJH-SDS, validated against video-fluoroscopy, is a simple bedside screen for sensitive identification of dysphagia and aspiration in the stroke population."(3).    

The BJH-SDS takes approximately 2 minutes to administer. Given the high incidence of dysphagia among stroke survivors, ideally every stroke patient would be assessed for dysphagia. Since it would not be practical for each stroke patient to receive a VFSS, the BJH-SDS offers a good alternative for many patients. 

ABOUT THE AUTHOR:

Jolie Parker, M.S.CCC-SLP received her Bachelor of Science in Communication Disorders from the University of Florida and her Master of Science in Speech-Language Pathology from the University of Central Arkansas. She specializes in the treatment of people who have dysphagia, or difficulty swallowing symptoms, such as: difficulty swallowing food, coughing or choking while eating, difficulty swallowing pills, coughing or choking when drinking liquids, recurrent lung infections or aspiration pneumonia. She is a co-inventor of the ISO Swallowing Exercise Device. Many of her dysphagia patients have been on PEG tubes, mechanical soft diets, pureed diets, and/or thickened liquids and have returned to regular foods and liquids after completing dysphagia exercises with the ISO Swallowing Exercise Device, including CTAR (Chin Tuck Against Resistance), JOAR (Jaw Opening Against Resistance), Effortful Swallow Against Resistance, and other dysphagia exercises.   

Jolie provides home therapy visits for adults and children with dysphagia in the central Florida area. She holds a Certificate of Clinical Competence from the American Speech-Language and Hearing Association (ASHA), a state license from the Florida Department of Health, and has 20 years of experience in clinical settings, hospitals, nursing homes, and home health care. She is the author of the ASHA approved CEU course for speech language pathologists: Using the ISO Swallowing Exercise Device in Dysphagia Therapy.

References

1. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke; a journal of cerebral circulation. 1999;30(4):744–748. [PubMed]    

2. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke; a journal of cerebral circulation. 2005;36(12):2756–2763. [PubMed]

3. Edmiaston, J, Connor, LT, Steger-May, K, Ford, A. A simple bedside stroke dysphagia screen, validated against video-fluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis. 2014 Apr; 23(4): 712–716.

4. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Stroke Practice Improvement Network I. Formal dysphagia screening protocols prevent pneumonia. Stroke; a journal of cerebral circulation. 2005;36(9):1972–1976. [PubMed]

5. Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D’Este C, Drury P, Griffiths R, Cheung NW, Quinn C, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet. 2011;378(9804):1699–1706. [PubMed]