Stroke units are clinical areas dedicated to the care of people admitted to hospital with stroke. Good practice dictates that people admitted to hospital with an acute stroke should be managed on a stroke unit. Stroke management is multiprofessional and interprofessional not only in its entirety of the pathway but also sections of the pathway such as the management of swallowing problems. The identification and management of dysphagia are important to minimise the risk of infection (usually because of poor mouth care), distress due to aspiration of food and liquids and the ability to provide adequate calories. Swallowing after stroke is variable therefore, constant awareness and review need to be undertaken to ensure that where problems exist, they are detected. found that there were people, who, 1 week after their stroke, had dysphagia which had not been noted at the time of their initial admission assessment.
Many older people will have presbyphagia, and depending on their frailty, the prevalence of dysphagia may be as high as 70% consequently, not all dysphagia on a stroke unit will be of a stroke origin. With an ageing society, the incidence/prevalence of dysphagia is increasing. Stroke affects swallowing at multiple levels due to the interruption of the feedback loop, with recovery depending on the cortical recovery. The events occur in a set order, but the duration of laryngeal elevation, UES opening and breath holding will vary depending on the bolus characteristics (volume and viscosity). The swallow is a synchronous and continuous event, once triggered. Swallowing is essentially a reflex, which follows a set pattern initiated in the brainstem. The act of swallowing is complex, not only peripherally but also centrally. In many cases, dysphagia resolves fairly quickly, but in others, the swallow will vary in function. Dysphagia is a common problem after stroke, with a reported prevalence up to 60%, which may rise to 100% if minor deficits such as minor tongue weakness are accepted as evidence of dysphagia.
0 kommentar(er)
