We know that between 50% and 80% of people who have had a stroke present with swallowing difficulties that may be associated with even a small lesion of the cortical or subcortical brain regions. This article provides an up-to-date overview of the current clinical decision-making that happens during the screening, assessment and management of swallowing difficulties post-stroke. It starts by describing screening assessments, typically carried out by nursing staff on every person who has had a stroke. Speech and language therapists (SLTs) are responsible for training said nursing staff in the implementation of the chosen swallow screen. This article suggests swallow screens should be used to assist in the prioritisation of clients and that all clients should ultimately be seen for a full assessment by the SLT. The assessment process commences with a clinical swallow examination that should guide future management, including decisions on further instrumental assessment as well as diet and fluid modifications. An instrumental assessment such as a videofluoroscopy is considered appropriate as long as clients are fit and able to participate. A fibreoptic endoscopic examination at bedside may be preferable if the client is unable to achieve the required positioning or is particularly unwell. Following a stroke, an instrumental examination can provide important guidance and monitoring of both compensatory manoeuvres as well as rehabilitative exercise programmes. The article finishes with a case example to fully illustrate the assessment and management of dysphagia post-stroke. Despite being a well-recognised area of clinical practice for SLTs in the UK, further research work is required to fully understand the incidence and risk of dysphagia in this group.
Swallow this: management of dysphagia post-stroke
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