European Stroke Organisation and European Society for Swallowing Disorders Guideline for the Diagnosis and Treatment of Post-Stroke Dysphagia

European Stroke Journal

Dziewas, R., Michou, E., et al. (2021).

European Stroke Journal, 6(3), LXXXIX-CXV.

This evidence-based clinical practice guideline provides recommendations on the screening, assessment and treatment of dysphagia in patients status post stroke. The target audience of this guideline includes all members of the multidisciplinary team.

European Stroke Organisation; European Society for Swallowing Disorders

All patients should receive a formal dysphagia screen by either water swallow test or multiple consistency test as fast as possible following admission secondary to acute stroke. Until such time that this screening can be conducted and swallowing has been judged to be safe, no administration of any food or liquid, including oral medication, is recommended (Strong For Recommendation, Moderate Evidence).

All stroke patients failing a dysphagia screen and/or showing other clinical predictors of post-stroke dysphagia (i.e., severe aphasia, severe dysarthria, severe facial palsy, and/or severe neurological deficit) should receive a dysphagia evaluation as soon as possible. In addition to clinical swallow examination, videofluoroscopic swallow study, or, preferably, fiberoptic endoscopic evaluation of swallowing should be available. Evaluation should routinely include swallowing of tablets, liquids, and different food consistencies and quantities (Weak For Recommendation, Low Evidence)

For individuals with dysphagia secondary to stroke, texture modification and/or thickened liquids may be utilized to reduce risk of pneumonia (Weak For Recommendation, Low Evidence). These modified textures and viscosities must only be prescribed based upon an appropriate assessment of swallowing (Strong for Recommendation, Low Evidence). Additionally, these patients should be monitored for fluid balance and nutritional intake (Strong For Recommendation, Moderate Evidence).

Behavioral swallowing exercises (defined as including exercises, maneuvers, postural changes, and expiratory muscle strength training within this guideline) to rehabilitate swallow function are recommended for individuals with dysphagia status post stroke, however the training program should be tailored to the specific swallowing impairment of the individual based upon assessment findings (Weak for Recommendation, Moderate Evidence).

Oral care interventions are recommended in patients with dysphagia secondary to stroke in order to reduced pneumonia risk (Weak for Recommendation, Low Evidence).

The use of neurostimulation techniques (i.e., repetitive transcranial magnetic stimulation, transcutaneous electrical stimulation, transcranial direct current stimulation, and pharyngeal electrical stimulation) is recommended as an adjunct to conventional dysphagia treatment for patients with dysphagia secondary to stroke to improve swallow functioning (Weak for Recommendation, Moderate Evidence). These neurostimulation techniques should preferably be conducted within a clinical trial setting (Strong for Recommendation, Low Evidence).

Treatment with pharyngeal electrical stimulation is recommended in individuals with tracheostomy and severe dysphagia secondary to stroke to accelerate decannulation (Weak For Recommendation, High Evidence). These neurostimulation techniques should preferably be conducted within a clinical trial setting (Low quality, Strong For Recommendation, Low Evidence).