Dysphagia is a relatively common consequence of stroke, with estimates between 50% and 60% of people presenting with swallowing dysfunction following stroke. It is associated with pneumonia, malnutrition and dehydration which in turn lead to increased length of hospital admission, poorer prognosis and morbidity. Speech and language therapists specialise in the assessment and management of swallowing difficulties and the profession have developed numerous therapies to manage the condition. Some of these are described as compensatory (strategies that provide immediate improvement in swallow safety but do not make permanent changes) other rehabilitative (therapy designed to restore swallow function). The aim of this study was to explore the practice patterns, including which approaches are used more frequently and what factors influence this, amongst SLTs in Australia in the treatment of dysphagia post stroke.

The researchers disseminated a 26-item online survey through four dysphagia interest groups to 538 SLTs. Of these, 118 surveys were returned fully completed. The results demonstrate that there is large variability in treatment practices of SLTs in Australia. And in contrast to the authors’ hypothesis, SLTs favour using compensatory strategies over rehabilitative strategies despite the shift in the research literature in support of the latter. SLTs report that the multitude of patient factors is the most common reason influencing their choice of approach. The authors also report that SLT experience and setting frequently influenced the choice of approach. Instrumental assessment (such as VDF) was only identified by a fifth of respondents as contributing to their decision making. It is important that practising SLTs be aware of the most relevant and up to date research in the area of dysphagia management. The authors suggest guidelines could support implementation and in the long term maximise outcomes for people with dysphagia post-stroke.

Dysphagia therapy post stroke: an exploration of the practices and clinical decision-making of speech-language pathologists in Australia.
Jones O, Cartwright J, Whitworth A, Cocks N.
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Anna Volkmer

UCL, London, UK.

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