Abstract
Objective
To expand the scope of prior spontaneous swallowing frequency analysis (SFA) studies,
by evaluating the role of SFA in dysphagia-and stroke-related outcomes at acute stroke
discharge.
Design
Period prevalence study.
Setting
Tertiary care university hospital.
Participants
Patients with acute stroke (N=96).
Interventions
Subjects were screened for dysphagia using SFA. Mode of screening was 24 hours from
identified stroke onset. All patients completed dysphagia- and stroke-related assessments.
Patients were followed to discharge from acute care, and admission SFA was compared
with status at discharge.
Results
Lower SFA rates at admission were significantly associated with presence of dysphagia.
Lower SFA rates were also associated with persistent dysphagia and restricted diet
at discharge. The SFA rates were lower for patients with identified aspiration on
fluoroscopic swallowing study. Negative stroke-related outcomes from acute care were
associated with lower SFA rates including disability at admission, disability and
handicap at discharge, and institutionalization at discharge. Regression analysis
identified SFA as an independent predictor of the negative composite outcome of death-disability-institutionalization.
Conclusions
Swallowing frequency analysis not only has a high accuracy of dysphagia identification
in acute stroke and relates to dysphagia severity, but it is also associated with
multiple dysphagia- and stoke-related outcomes from acute care. Early poststroke dysphagia
identification with SFA may lead to earlier and more effective interventions targeted
at identified negative stroke outcomes.
Keywords
List of abbreviations:
FOIS (Functional Oral Intake Scale), MASA (Mann Assessment of Swallowing Ability), mRS (modified Rankin Scale), NIHSS (National Institutes of Health Stroke Scale), SFA (swallowing frequency analysis), SLP (speech-language pathology)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Formal dysphagia screening protocols prevent pneumonia.Stroke. 2005; 36: 1972-1976
Mohr NJ, Baldwin NX, White P. Analysis of the implementation of a validated swallowing screening tool for acute stroke: modified MASA [Abstract #2024]. Paper presented at: European Stroke Conference. May 22, 2012; Lisbon, Portugal.
- Utility of dysphagia screening results in predicting post stroke pneumonia.Stroke. 2010; 41: 2849-2854
- Clinical epidemiology: a basic science for clinical medicine.2nd ed. Little Brown and Company, Boston1991
- Epidemiology: an introductory text.2nd ed. W.B. Saunders, Philadelphia1985
- Dysphagia and aspiration after stroke: Evidence-Based Review of Stroke Rehabilitation (EBRSR) version 15, 2010.(Available at:)http://www.ebrsr.com/evidence-review/15-dysphagia-and-aspiration-following-strokeDate accessed: January 28, 2013
- Valid items for screening risk in patients with stroke: a systematic review.Stroke. 2012; 43: 892-897
- Swallowing screens after acute stroke: a systematic review.Stroke. 2012; 43: 869-871
- Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke.Stroke. 2013; 44: 3452-3457
- Spontaneous swallow frequency compared with clinical screening in the identification of dysphagia in acute stroke.J Stroke Cerebrovasc Dis. 2014; 23: 2047-2053
- Clinical epidemiology: the essentials.3rd ed. Lippincott Williams & Wilkins, Baltimore1996
- Validation and demonstration of an isolated acoustic recording technique to estimate spontaneous swallow frequency.Dysphagia. 2013; 28: 86-94
- Acoustic discrimination of healthy swallows from upper airway movements.J Acoust Soc Am. 2013; 134: EL127-EL132
- Methodology for detecting swallowing sounds.Dysphagia. 1994; 9: 54-62
- Symmetry and reproducibility of swallowing sounds.Dysphagia. 1994; 9: 168-173
- The Mann assessment of swallowing ability (MASA).Thompson Delmar Learning, San Diego2002
- Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients.Arch Phys Med Rehabil. 2005; 86: 1516-1520
- Measurements of acute cerebral infarction: a clinical examination scale.Stroke. 1989; 20: 864-870
- Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial.Stroke. 1997; 28: 307-310
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Cerebral vascular accidents in patients over the age of 60. II. Prognosis.Scott Med J. 1957; 2: 200-215
- Improving the sensitivity of the Barthel Index for stroke rehabilitation.J Clin Epidemiol. 1989; 42: 703-709
- Measurement in neurological rehabilitation.Oxford University Press, Oxford, England1992
- Assessment of coma and impaired consciousness. A practical scale.Lancet. 1974; 2: 81-84
- More powerful procedures for multiple significance testing.Stat Med. 1990; 9: 811-818
- Differences in the diagnostic accuracy of acute stroke clinical subtypes defined by multimodal magnetic resonance imaging.J Neurol Neurosurg Psychiatry. 2003; 74: 886-888
- Dysphagia in acute stroke: incidence, burden and impact on clinical outcome.PLoS One. 2016; 11e0148424
Article info
Publication history
Published online: February 05, 2019
Footnotes
Disclosures: Giselle Carnaby and Michael Crary are associated with a patent application and license by the University of Florida and Innara Health. The other author has nothing to disclose.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
