DYSPHAGIA THERAPY FOLLOWING STROKE - A CONTROLLED TRIAL

Objective: To determine the effect, of graded levels of intervention b y a dysphagia therapist on the occurrence of pneumonia, dehydration, c alorie-nitrogen deficit, recurrent upper airway obstruction, and death following stroke. Design: A randomized control trial, Setting: Inpati ent stroke rehabilitation unit. Patients: All patients met the followi ng eligibility criteria: (1) stroke defined by clinical history and ne urologic examination with compatible CT or MRI, (2) ages 20 to 90 year s inclusive, (3) no known history of significant oral or pharyngeal an omaly, (4) laboratory values below end point criteria, (5) failure on the Burke Dysphagia Screening Test, and (6) modified barium swallow ev aluation evidence of dysphagia (patients who aspirated greater than or equal to 50% of all consistencies presented, even using compensatory swallowing techniques, were excluded). Of 123 eligible patients, eight refused study participation. One hundred fifteen patients were random ized. Interventions: Three graded levels of dysphagia therapist contro l of diet consistency and reinforcement of compensatory swallowing tec hniques were provided during the inpatient rehabilitation stay. Main o utcome measures: Pneumonia, dehydration, calorie-nitrogen deficit, rec urrent upper airway obstruction, and death. Results: The log rank stat istic showed no significant difference between the three treatment gro ups for the distribution of time until end point during the inpatient stay or to 1 year post-stroke. Conclusion: Limited patient and family instruction regarding use of diet modification and compensatory swallo wing techniques during inpatient rehabilitation is as effective as the rapist control of diet consistency and daily rehearsal of compensatory swallowing techniques for the prevention of medical complications ass ociated with dysphagia following stroke.