As mentioned on the Neurology & Physiology page of this website, there is a vast range of possible swallowing deficits that can arise following a stroke. Furthermore, it has been shown that post-stroke dysphagia can occur in any stage of the swallowing process (Groher and Crary, 2010). For the purposes of this section, specific reference is not made to the various types of incoordination and impairment that can occur throughout the anatomical components of the swallow post-stroke. Rather, the assessment section focuses on the reported fact that patients with bilateral hemispheric stroke are twice as likely to aspirate than patients with unilateral stroke (Horner, Massey, and Brazer, 1990). Accordingly, this section discusses clinical and instrumental assessments in relation to detection of aspiration.
The high risk of aspiration in patients with bilateral hemispheric stroke requires a rigorous and methodical assessment that is both holistic and considerate of the patient's condition and background. This section of the website discusses:

As this website is focused on patients with bilateral hemispheric stroke within the acute phase of hospital care, it is possible that due to the patient's overall condition, an instrumental assessment may not be possible within the first week post-stroke. This does not reduce the importance of instrumental assessment - while the clinical assessment is upheld as a means of gathering valuable information about the patient's swallow and non-penetrative dysphagia, the instrumental assessment is highly regarded in terms of its accuracy in identifying aspiration. Furthermore, instrumental assessment allows the clinician to visualise the coordination and structure of certain swallowing anatomy, while the clinical assessment only allows the SLT to infer its integrity.
Ongoing assessment is also an important consideration as stroke patients' dysphagia can improve over time (Daniels and Huckabee, 2008). Post-acute reassessment allows the clinician to ensure that dysphagia intervention is effective and appropriate (Heckert, Komaroff and Barrett, 2009).