Best Practice Recommendations for Stroke Patients With Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation
Dysphagia
Umay, E., Eyigor, S., et al. (2021).
Dysphagia, 36, 800-820.
This is a guideline providing consensus-based recommendations on the management of dysphagia in patients with stroke. This guideline is part two of a consensus study. For more information, please see the Notes on this Article section.
Turkish Society of Physical Medicine and Rehabilitation (PMR)-Dysphagia Working Group
<div>The data in this guideline are included in another document which can be found in the Associated Article section below. This guideline is alson part one of a consensus study of experts in Turkey. Part one of this study is also included in this Evidence Map:</div>
<ul>
<li>Umay, E., Eyigor, S., Ertekin, C., Unlu, Z., Selcuk, B., Bahat, G., Karahan, A. Y., Secil, Y., Gurcay, E., Kıylioglu, N., Yavuz Keles, B., Giray, E., Tikiz, C., Albayrak Gezer, I., Yalıman, A., Sen, E. I., Vural, M., Saylam, G., Akaltun, M. S., Sari, A., … Mercimekci, S. (2022). Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up. Dysphagia, 37(2), 217–236. https://doi.org/10.1007/s00455-021-10273-9</li>
</ul>
Swallowing rehabilitation may include a core set of passive and/or active treatments to prevent aspiration. The following treatments have been shown to be effective and should be considered as first-line treatments for patients with dysphagia post stroke: <br />
<ul>
<li>Patient/family education pertaining to dysphagia, its complication and treatment options,</li>
<li>Oral hygiene and oral care, and</li>
<li>Compensatory and therapeutic methods based on patient’s defined dysphagia problem (dysphagia state and severity),</li>
<li>Upright positioning for orally fed patients, </li>
<li>Bolus volume modification,</li>
<li>Oral sensory stimulation (Overall Consensus).</li>
</ul>
The following treatments did not have sufficient information regarding their effectiveness and are recommended as third-line treatments for patients with dysphagia post stroke:<br />
<ul>
<li>Biofeedback (Overall Consensus), and</li>
<li>Electrical stimulation and biofeedback (Approaching Consensus).</li>
</ul>
The following treatments have been shown to be somewhat efective and should be considered as second-line treatments for patients with dysphagia post stroke:<br />
<ul>
<li>Swallowing maneuvers (e.g., Mendelson and Masako) (Overall Consensus), </li>
<li>Texture modification (Overall Consensus), </li>
<li>Oral motor strengthening exercises (Approaching Consensus), and </li>
<li>Electrical stimulation (Overall Divergence).</li>
</ul>
<p class="MsoNormal">All stroke patients with dysphagia or at risk for aspiration should be included in a swallowing rehabilitation program. Treatment should be individualized and initiated as soon as possible (Overall Consensus).</p>
Stroke patients with dysphagia or at risk for aspiration should receive an instrumental assessment to determine course of swallowing rehabilitation (Approaching Consensus).
