15. Dysphagia pg. 1 of 65 www.ebrsr.com 15. Dysphagia and Aspirat ion Post St roke Robert Teasell MD, Norine Foley MSc, Rosemary Martino, PhD, Sanjit Bhogal MSc, Mark Speechley PhD Key Points There is a high incidence of dysphagia and aspiration following acute stroke. VMBS studies are the only sure way of diagnosing dysphagia and aspiration. The incidence of silent aspiration following acute stroke is high. The risk of developing pneumonia following stroke is proportional to the severity of aspiration. All stroke survivors should remain NPO until a trained assessor has assessed swallowing ability. Following a failed screening, a referral to a Speech-Language Pathologist should be made for further assessment and management. Feeding assistance should be provided by an individual trained in low- risk feeding strategies. Individuals with dysphagia should feed themselves whenever possible. Dysphagia diets, consisting of texture-modified solid foods and partially thickened fluids may help to reduce the incidence of aspiration pneumonia. Treatments with Nifedipine, transcranial magnetic stimulation and head rotation techniques can be used to improve swallowing mechanics, while thermal stimulation may not. Enteral tube feeding may be necessary when stroke patients fail to meet their nutritional needs orally. There is no difference in the outcomes of death or poor outcome associated with the use of either nasogastric or gastro-enteric feeding tubes. It is uncertain if the use of electrical stimulation improves swallowing function post stroke. Last updated Sept 2012 The Evidence-Based Review of Stroke Rehabilitation ( EBRSR) reviews current practices in stroke rehabilitation. Contacts: Dr. Robert Teasell 801 Commissioners Road East London, Ontario, Canada N6C 5J1 Phone: 519.685.4000 Web: www.ebrsr.com Email: Robert.teasell@sjhc.lo ndon on ca