ACUTE DYSPHAGIA MANAGEMENT AFTER BILATERAL HEMISPHERIC STROKE
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Sourced from: http://www.amputee-coalition.org/senior_step/bibliography01.jpg


This website aims to provide Speech Language Therapists with dysphagia management and assessment information for working with, and caring for the >65 bilateral hemispheric stroke population. The information given applies only to the acute hospital setting; one week post stroke. For a definition of stroke click here. For the purpose of this website bilateral hemispheric stroke is defined as a stroke in one hemisphere with a history of unilateral stroke in the other.

Dysphagia is the medical term for symptoms of difficulty at any stage of the swallow (Groher & Crary, 2010). Although research shows great discrepancy in defining prevalence of dysphagia following stroke (Daniels & Huckabee, 2008) the Ministry of Health (2010) states that approximately 50% of all patients admitted to hospital post stroke have symptoms of dysphagia. This high prevalence is important because the presence of dysphagia after stroke is associated with increased risk of pulmonary complications and mortality; early detection of dysphagia during the acute stage reduces the occurrence of these complications and decreases the length of hospital stay and overall healthcare expenditure (Martino, Foley, Bhogal, Diamant, Speechley & Teasell, 2005). These statistics highlight the importance of dysphagia assessment and management in the acute hospital setting.

Patients with bilateral lesions present with the most severe dysphagia. Damage to the left hemisphere is associated with an aspiration incidence of 63%, damage to the right 70% and bilateral damage has a 100% incidence of aspiration (Alberts, Horner, Gay & Brazer, 1992). Reasons for the difference in incidence will be discussed in the neurology section of this website.

The flowchart below provides an overview of the management process of dysphagia for patients with bilateral hemispheric stroke. Due to the specificity of this population, some of the points in the flowchart will be covered in greater detail than others. Throughout all stages of this website particular emphasis is placed on the severe nature of bilateral damage, the extreme variability of presenting symptoms and the inability of contralateral cortical re-organisation to occur.



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