Lin Perry, MSc, RGN, RNT,
Faculty of Health & Social Care Sciences,
Kingston University and St. George's Hospital Medical School:
Sir Frank Lampl Building, Kingston University,
Kingston upon Thames, Surrey, UK.
Introduction
Stroke is a major cause of mortality and morbidity in all industrialized countries1--incidence of a first-in-a-lifetime stroke in the UK is estimated at 2.4 per 1,000 population per year, with all strokes combined having an incidence 20-30% higher.2
Dysphagia is a frequent accompaniment to stroke.3-5 Depending upon manner and timing of assessment, dysphagia is detected in 30-65% of acute stroke patients6-10 with a small proportion experiencing clinically 'silent' aspiration of food/ fluids.9,10 Dysphagia is associated with increased morbidity and mortality. Whilst this may partly be explained by its relationship with increased stroke severity, dysphagia also exerts an independent effect revealed by the tripling of mortality rates in alert dysphagic stroke patients compared to similar groups with intact swallow.8 It is associated with chest infection independent of aspiration7 which also risks chemical pneumonitis, infection and airway obstruction.11,12 Although dysphagia frequently resolves rapidly, for a minority it produces enduring disability and handicap. Stroke-related impaired swallowing has been found in 5.
