Depending on the region of lesion, bilateral stroke may leave a patient with several physical and mental impairments that need to be addressed during the acute or hospitalised period. The following factors need to be considered when planning dysphagia intervention for a survivor of bilateral stroke as they can have significant impacts on the success and outcome of swallowing therapy.

Mental Status - Alertness, Stamina and Cognitive FunctionDuring the period of hospitalisation following bilateral hemispheric stroke, a patient will lapse in and out of various states of alertness and will have reduced energy and stamina due to the massive shock their body has recently undergone (Groher and Crary, 2010). Trying to identify appropriate strategies for swallowing therapy may therefore be difficult when a patient is only semi-alert or fatigued. Clinicians should keep in mind that patient fatigue can alter the patient’s response to therapy; treatment options cannot necessarily be ruled out due to a lack of response to stimulus or an observed decrease in swallowing safety and efficiency when the patient is showing signs of fatigue (Groher and Crary, 2010). Cognitive impairments can present significant challenges to the success of swallowing therapy if a patient is non-compliant or struggles to understand the reasons a therapy approach is being undertaken.

AphasiaA large proportion of patients display expressive and/or receptive Aphasia following stroke (Ministry of Health, 2003). Due to the severity of bilateral stroke, it is highly likely that patients from this client population will exhibit some form of Aphasia. Patients with Aphasia may struggle to describe their swallowing difficulties and understand and feedback to the clinician in regard to the therapy process. Speech Language Therapists therefore need to be skilled in the techniques of supported communication in order to help facilitate as much patient involvement in the therapy process as possible. In circumstances where the patient cannot participate by any means in the decision making process, their next of kin should be the fully involved in and informed about the therapy process.
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Apraxia of SpeechApraxia is a motor disorder resulting from injury to the region of the brain involved in motor planning. A patient with Apraxia of speech knows what words they want to say but a breakdown occurs in speech production as the brain has difficulty coordinating the muscle movements required to say those words (Freed, 2000). Comprehension is unimpaired in Apraxia of speech which can result in patients becoming highly frustrated with their inability to articulate words correctly. When a stroke survivor presents with dysphagia, apraxia of speech and aphasia, communication will be severely impaired and strategies to enable effective communication must be established.
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DysarthriaDysarthria is a motor speech disorder that can result from Stroke or another form of neurological disorder (Freed, 2000). Dysarthria affects the muscles of phonation, respiration and articulation which in turn can affect the resonance and prosodic features of speech. Muscles may show a reduced range of movement and reduced speed and accuracy of movement. In severe cases, muscles may be completely paralysed which has significant implications for speech, respiration and swallowing. It is highly probable that a patient presenting with dysphagia as a result of bilateral hemispheric stroke will co-currently present with dysarthria.
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