17 These particles may accumulate for several seconds until a critical mass is reached and the pharyngeal stage of the swallow takes place. 14- 16 Between mastication cycles particles that have reached the appropriate size and consistency are moved to the dorsal tongue surface and are transferred to the oropharynx (Stage 2 transport). During mastication oral structures work to reduce bolus size and soften it in preparation for the pharyngeal stage. In contrast, when eating solids, the tongue shifts backwards and rotates its surface to one side pulling the food back to the molar region and placing it on the occlusal surfaces for mastication (also known as stage 1 transport). The tongue-palate contact area expands posteriorly and squeezes the liquid bolus into the oropharynx. During the propulsive stage the tip of the tongue contacts the hard palate behind the upper anterior teeth and the tongue surface moves upward. Once a liquid bolus is ingested it is sealed off between dorsal tongue and the soft palate to prevent leakage into the pharynx until ready for swallowing. 9 More than 1/3 of patients avoid eating with others because of dysphagia. Only 45% of patients with dysphagia find eating enjoyable, and 41% of patients with dysphagia experience anxiety or panic during mealtimes. 8ĭysphagia can adversely impact quality of life. (1987) reported that approximately 58% of acute stroke survivors with dysphagia had signs of dehydration (urea concentration of 10 mmol/l or higher) compared to 32% of those that were not dysphagic. One study reported that 49% of stroke survivors admitted to a rehabilitation unit were malnourished, and that malnutrition was associated with dysphagia. Dehydration and malnutrition also are common in dysphagic patients especially those who receive thickened liquids or modified diets.
6 In the same study mortality was more than 30% in stroke survivors with dysphagia. Dysphagia identified during bedside clinical examination was associated with an increase of 17% in the incidence of pulmonary infection compared to those that were not dysphagic (33% vs. The most feared complication of dysphagia after stroke is aspiration pneumonia. 3, 4 One study reported that 80% of patients with prolonged dysphagia required alternative means of enteral feeding. 2 Fortunately, the majority of these patients recover swallowing function within 7 days, and only 11-13% remain dysphagic after 6 months.
Dysphagia affects more than 50% of stroke survivors.
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