Dysphagia Treatment in Pontine Stroke

Stroke is the most leading cause of dysphagia in which most stroke patients experience  dysphagia or difficulties in swallowing and need Nasogastric tube (NGT) insertion for  temporary feeding purposes. Patients who have swallowing difficulties or dysphagia are  usually referred to the Speech Therapist (ST) in acute settings or for rehabilitation. Speech  therapists will usually conduct a clinical bedside swallowing assessment for patients after  stroke in acute settings. When a patient is not safe for oral feeding, NGT will be suggested to  be inserted by ST. Patients with NGT need to undergo post-stroke rehabilitation therapy for  weeks or months depending on the severity of the stroke whether the patient requires a long  term NGT or short term NGT. Patients who showed risk of silent aspiration would undergo  Fibreoptic Endoscopic Evaluation of Swallowing (FEES) as a gold standard objective  assessment for swallowing. During acute settings if the prognosis of swallowing is poor,  medical teams usually suggest Percutaneous Endoscopic Gastrostomy (PEG tube) insertion  for acute stroke if long-term enteral feeding is required. Tube dependent oral areas for a  longer time were higher in the lesions located on the pons and medulla than in lesions located in other areas of the brain. Post stroke swallowing rehabilitation is important to look into  patient progress. Aim of this study is to assist the speed recovery for patients with absent  hyolaryngeal movement with using vital stim alongside with conventional swallowing therapy.  A case study conducted on 83 years old female and 68 years old male diagnosed with acute  pontine stroke. Patient presented with silent aspiration, absent hyolaryngeal excursion and  absent pharyngeal sensation during Fiberoptic Endoscopic Evaluation of Swallowing (FEES).  83 years old female undergo conventional swallowing therapy whereas 68 years male undergo  conventional swallowing therapy along side with Vital Stim Therapy. Both patients showed  recovery of starting oral feeding and weaning off the nasogastric tube (NGT). However, an 83  years old female took almost 6 months to wean off NGT compared to a 68 year old male.  Vital stim along with conventional swallowing therapy showed much more speed recovery  compared to only conventional swallowing therapy.  

Keywords FEES (Fiberoptic Endoscopic Evaluation of Swallowing), NGT (Nasogastric Tube), Silent  Aspiration, Hyolaryngeal Excursion