#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The role of FEES and the dysphagia team in the management of patients after stroke disease in Hospital České Budějovice


Authors: M. Huška 1 ;  Koptíková L. 1,2;  P. Lukeš 3 ;  L. Mrzena 1
Authors‘ workplace: Oddělení otorinolaryngologie a chirurgie hlavy a krku, Nemocnice České Budějovice, a. s. 1;  Fonoral s. r. o., Strakonice 2;  Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha 3
Published in: Otorinolaryngol Foniatr, 71, 2022, No. 4, pp. 196-201.
Category: Original Article
doi: https://doi.org/10.48095/ccorl2022196

Overview

Introduction: The prevalence of dysphagia in the general population is 6–16%. The dysphagia team focuses on dia­gnosis and treatment of dysphagia. The dysphagia team consists of a clinical speech therapist, an otorhinolaryngologist and nurse (depending on the workplace). Other specialties such as radiologist, nutritionist and physiotherapist can also be a member of the team. FEES (Flexible Endoscopic Evaluation of Swallowing) and VFSS (Videofluoroscopic Swallow Study) are used as the gold standard for objective examination of the dysphagia. Aim of the work: The aim of the work is to evaluate retrospectively the contribution of the dysphagia team working in the department of otorhinolaryngology in Hospital České Budějovice, in the care of patients after stroke disease indicated for examination from the Complex Cerebrovascular Center (CCC) in 2016–2020. Material and methods: The retrospective study included 33 patients after stroke with clinical suspicion of dysphagia, who were referred from the CCC to the Counseling Center for Swallowing Disorders for objective examination of dysphagia. Results: In 9 patients (27.3%), dysphagia was ruled out during FEES, thus enabling oral intake without restrictions. Dysphagia was confirmed in 24 patients (72.7%). Ten patients (30.3%) had a prolonged pharyngeal swallowing phase without food penetration into the airways. Three patients (9.1%) had a bolus penetration into the airways during the examination, but it remained above the vocal cords and it was completely expelled from the airways (PAS 2). In 11 cases (33.3%) aspiration was found, of which nine cases (27.3% of all patients, 81.8% of patients with aspiration) involved silent aspiration without any attempt to expel bolus from the airways (PAS 8). Conclusion: In 31 patients (94.0%) the benefit of examination by the dysphagia team was noted. In the case of 22 patients (66.7%), it was an adjustment of nutrition and swallowing rehabilitation with confirmed dysphagia. Restrictions were lifted in 9 patients (27.3%) with false-positive screening and clinical examination. We observe a positive effect of long-term swallowing rehabilitation in 61.5% of the monitored patients.

Keywords:

endoscopy – stroke – rehabilitation – deglutition disorder


Sources

1. Černý M, Kotulek M, Chrobok V. FEES – flexi­bilní endoskopické vyšetření polykání. Endoskopie 2011; 20 (2): 70–75.

2. Arnold M, Liesirova K, Broeg-Morvay A et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One 2016; 11 (2): e0148424. Doi: 10.1371/journal.pone.0148424.

3. Braun T, Juenemann M, Viard M et al. Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study. BMC Neurol 2019; 19 (1): 282. Doi: 10.1186/s12883-019-1499-8.

4. Huang KL, Liu TY, Huang YC et al. Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy. J Stroke Cerebrovasc Dis 2014; 23 (10): 2547–2553. Doi: 10.1016/j.jstrokecerebrovasdis. 2014.05.031.

5. Martino R, Foley N, Bhogal S et al. Dysphagia after stroke: incidence, dia­gnosis, and pulmonary complications. Stroke 2005; 36 (12): 2756–2763. Doi: 10.1161/01.STR.0000190056.76 543.eb.

6. Tedla M, Chrobok V. Poruchy polykání. Havlíčkův Brod: Tobiáš 2009.

7. Vališ M, Šimůnek L, Chrobok V et al. Poruchy polykání u neurologických onemocnění. Prakt Lék 2014; 94 (6): 254–258.

8. Garcia-Peris P, Paron L, Velasco C et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life. Clin Nutr 2007; 26 (6): 710–717. Doi: 10.1016/j.clnu.2007.08.006.

9. Maclean J, Cotton S, Perry A. Post-laryngectomy: it‘s hard to swallow: an Australian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia 2009; 24 (2): 172–179. Doi: 10.1007/s00455- 008-9189-5.

10. Bax L, McFarlane M, Green E et al. Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: functional outcomes for patients after stroke. J Stroke Cerebrovasc Dis 2014; 23 (3): e195–200. Doi: 10.1016/ j.jstrokecerebrovasdis.2013.09.031.

11. Park KD, Kim TH, Lee SH. The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review. Int J Nurs Stud 2020; 107: 103588. Doi: 10.1016/ j.ijnurstu.2020.103588.

12. Teuschl Y, Trapl M, Ratajczak P et al. Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit. PLoS One 2018; 13 (2): e0192142. Doi: 10.1371/journal.pone.0192142.

13. Braun T, Juenemann M, Viard M et al. What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study. BMJ Open 2018; 8 (3): e019016. Doi: 10.1136/bmjopen-2017-019016.

14. Ishida K. Complications of stroke: An overview. UpToDate. 2022 [online]. Dostupné z: https: //www.uptodate.com/contents/complications-of-stroke-an-overview

15. Gonzalez-Fernandez M, Brodsky MB, Palmer JB. Poststroke Communication Disorders and Dysphagia. Phys Med Rehabil Clin N Am 2015; 26 (4): 657–670. Doi: 10.1016/j.pmr.2015.06. 005.

16. Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? Age Ageing 2007; 36 (1): 90–94. Doi: 10.1093/ageing/afl149.

17. Warnecke T, Ritter MA, Kroger B et al. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28 (3): 283–289. Doi: 10.1159/000228 711.

18. Václavík D, Solná G, Lasotová N et al. Péče o pacienty s dysfagií po cévní mozkové příhodě. Standard léčebného plánu. Cesk Slov Neurol N 2015; 78 (6): 721–727.

19. Warnecke T, Im S, Kaiser C et al. Aspiration and dysphagia screening in acute stroke – the Gugging Swallowing Screen revisited. Eur J Neurol 2017; 24 (4): 594–601. Doi: 10.1111/ene.13251.

20. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11 (2): 93–98. Doi: 10.1007/BF00417897.

Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#