Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Abstract

Purpose of review: We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia?

Recent findings: There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.

Keywords: Deglutition; Dysphagia; Rehabilitation; Stroke.

Fig. 1

Swallowing evaluations in a 58-year-old man in the chronic stage following stroke. (a) Videofluoroscopic swallow study frame in a rest position prior to swallowing with anatomic labels; (b) video frame mid-swallow; arrow identifies aspirated material; and (c) pharyngeal high-resolution manometry spatiotemporal plot displaying pressure generated over the entire swallow; hypopharyngeal pressures are generated at the level of the larynx. Studies were performed on the same patient on the same day