Interventions for dysphagia and nutritional support in acute and subacute stroke

Clinical Pharmacology and Pharmacy, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka, 8.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 10/2012; 10(10):CD000323. DOI: 10.1002/14651858.CD000323.pub2
Source: PubMed


Stroke is often complicated by problems with swallowing (dysphagia) and poor nutrition. Normal oral feeding in those with swallowing problems may lead to pneumonia and an increased risk of death. Therapies to improve swallowing are designed to accelerate recovery of swallowing function and reduce the risk of developing pneumonia. We reviewed 33 studies involving 6779 patients (the average age of patients across the studies was 71 years). There was some evidence that acupuncture and behavioural interventions may reduce dysphagia but the roles of drug therapy, neuromuscular electrical stimulation, pharyngeal electrical stimulation, physical stimulation, transcranial direct current stimulation, and transcranial magnetic stimulation remain unclear. Liquid food may be given directly into the stomach through feeding tubes, either via the gullet, using a nasogastric tube (NGT), or directly into the stomach via a percutaneous endoscopic gastrostomy (PEG) tube. Starting tube feeding (with either NGT or PEG) early after stroke may reduce death although the information available remains inconclusive. If longer-term feeding is required PEG feeding provides better nutrition and is more secure than a NG tube. The available trial evidence does not support the routine use of protein and energy supplements in acute stroke patients who are able to take food by mouth; supplements may show benefit in those who have signs of malnutrition, for example through reducing pressure sores.

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    • "Impaired feeding which results in malnutrition is frequently observed in patients with dysphagia after stroke[37]. About 50 % of stroke patients have feeding difficulties due to dysphagia[38]. In older patients reduced nutritional status might be observed already at hospital admission with the diagnosis of acute stroke[39]. "
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    ABSTRACT: Background: Patients with stroke are at a high risk for long-term handicap and disability. In the first weeks after stroke muscle wasting is observed frequently. Early post-stroke rehabilitation programs are directed to improve functional independence and physical performance. Supplementation with essential amino acids (EAAs) might prevent muscle wasting and improve rehabilitation outcome by augmenting muscle mass and muscle strength. We aim to examine this in a double blinded, randomized placebo-controlled clinical trial. Methods: Patients with ischemic or haemorrhagic stroke will be enrolled at begin of the early post-stroke rehabilitation in a parallel group interventional trial. Oral supplementation of EAAs or placebo will be given for 12 weeks in a double blinded manner. Physical and functional performance will be assessed by exercise testing before supplementation of EAAs as well as at discharge from the in-patient rehabilitation, at 12 weeks and 1 year afterwards. Discussion: This is the first randomized double-blinded placebo-controlled clinical study aiming to assess the effect of the EAAs supplementation on muscle strength, muscle function and physical performance in stroke patients during early post-stroke rehabilitation. Supplementation of EAAs could prevent muscle mass wasting and improve functional independence after stroke. Trial registration: The study is registered at the German registry for clinical trials as well as at World Health Organization (WHO; number DRKS00005577).
    Full-text · Article · Dec 2016 · BMC Neurology
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    • "Patients who remain chronically dysphagic require enteral feeding through a nasogastric tube (NG) or percutaneous endoscopically introduced gastrostomy tube (PEG) and are more likely to require long-term institutional care [3]. Although dysphagia may be treated by a number of techniques, there are no definitive interventions [4]. Human swallowing has bilateral representation in the cerebral cortex but commonly with a dominant hemisphere (which is unrelated to handedness) [5]. "
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    ABSTRACT: . Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods . We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes were radiological aspiration (penetration aspiration score, PAS) and clinical dysphagia (dysphagia severity rating scale, DSRS) at 2 weeks; secondary outcomes included functional outcome, death, and length of stay in hospital. Results . Three completed trials were identified: 73 patients, age 72 (12) years, severity (NIHSS) 11 (6), DSRS 6.7 (4.3), mean PAS 4.3 (1.8). Compared with no/sham stimulation, PES was associated with lower PAS, 3.4 (1.7) versus 4.1 (1.7), mean difference −0.9 ( p = 0.020 ), and lower DSRS, 3.5 (3.8) versus 4.9 (4.4), mean difference −1.7 ( p = 0.040 ). Length of stay in hospital tended to be shorter: 50.2 (25.3) versus 71.2 (60.4) days ( p = 0.11 ). Functional outcome and death did not differ between treatment groups. Conclusions . PES was associated with less radiological aspiration and clinical dysphagia and possibly reduced length of stay in hospital across three small trials.
    Full-text · Article · Dec 2015 · Stroke Research and Treatment
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    • "Dysphagia is a common complication after stroke and is associated, independently, with a poor outcome. Although there are a number of interventions that show promise for treating dysphagia, none have definitive data[4]. Three trials have now been reported assessing the safety and efficacy of Table 3: Comparison of outcomes at 2 weeks and discharge from hospital in 73 patients across three trials by treatment assignment (pharyngeal electrical stimulation versus sham/placebo). "

    Full-text · Article · Dec 2015 · International Journal of Stroke
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