RSS-Feed abonnieren
DOI: 10.1055/s-0032-1332948
Schluckstörungen nach Schlaganfall
Pragmatisches Vorgehen in der FrührehabilitationDysphagia after StrokePractical Management in Early RehabilitationPublikationsverlauf
Publikationsdatum:
13. März 2013 (online)
Zusammenfassung
Schluckstörungen treten bei über 60 % der Patienten in der akuten Phase nach Schlaganfall auf. Die mit der Schluckstörung assoziierte Pneumonie ist die häufigste Todesursache unter den medizinischen Komplikationen nach Schlaganfall. Der rechtzeitige Nachweis von Schluckstörungen und die damit einhergehende individualisierte Ernährungsstrategie reduziert diese Komplikation. Die frühzeitige Behandlung verbessert nachweislich die Schluckstörung und reduziert das Risiko für Aspiration und Pneumonie nach Schlaganfall. Es wird ein pragmatisches klinisches Vorgehen in der Diagnostik und Therapie von Schluckstörungen nach Schlaganfall in der Frührehabilitation vorgestellt.
Abstract
Dysphagia affects more than 60 % of acute stroke survivors. Pneumonia due to dysphagia is the most common cause of death after stroke. The early diagnosis of dysphagia and an individualised feeding strategy reduces the incidence of pneumonia and improves the outcome after stroke. Early treatment of dysphagia improves swallowing function and reduces the risk for aspiration and pneumonia after stroke. A pragmatic clinical management of dysphagia in early rehabilitation after stroke is presented.
-
Literatur
- 1 Martino R, Foley N, Bhogal S et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763
- 2 Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter?. Age Ageing 2007; 36: 90-94
- 3 Davalos A, Ricart W, Gonzalez-Huix F et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996; 27: 1028-1032
- 4 Daniels SK, McAdam CP, Brailey K. Clinical assessment of swallowing and prediction of dysphagia severity. Am J Speech Lang Pathol 1997; 6: 17-24
- 5 Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36: 1972-1976
- 6 Prosiegel M, Heintze M, Wagner-Sonntag E et al. Deglutition disorders in neurological patients. A prospective study of diagnosis, pattern of impairment, therapy and outcome. Nervenarzt 2002; 73: 364-370
- 7 Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on acute stroke pathways: quality is cost effectiv. Arch Phys Med Rehabil 1995; 76: 1130-1133
- 8 Prosiegel M, Riecker A, Weinert M et al. Management of dysphagic patients with acute stroke. Nervenarzt 2012; Nov 11. [Epub ahead of print]
- 9 Suntrup S, Meisel A, Dziewas R et al. Dysphagiediagnostik und -therapie des akuten Schlaganfalls. Eine bundesweite Erhebung auf zertifizierten Stroke-Units. Nervenarzt 2012; im Druck
- 10 Dias Marques CH, Zuma de Rosso AL, Andrè C. Bedside assessment of swallowing in stroke: water tests are not enough. Top Stroke Rehabil 2008; 15: 378-383
- 11 Daniels SK, Andersson JA, Wilson PC. Valid items for screening Dysphagia risk in patients with stroke. Stroke 2012; 43: 892-897
- 12 Wilson RD, Howe EC. A Cost-Effectiveness Analysis of Screening Methods for Dysphagia after Stroke. Physical Medicine and Rehabilitation 2012; 4: 273-282
- 13 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2: 216-219
- 14 Langmore SE, Schatz K, Olsen N. Endoscopic and video-fluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol 1991; 100: 678-681
- 15 Perry L. Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses. J Clin Nurs 2001; a 10: 463-473
- 16 Perry L. Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses. J Clin Nurs 2001; b 10: 474-481
- 17 Sellars C, Bowie L, Bagg J et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007; 38: 2284-2291
- 18 Langmore SE, Terpenning MS, Schork A et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia 1998; 13: 69-81
- 19 Dinitz PB, Vanin G, Xavier R et al. Reduced incidence of aspiration with spoon-thick consistency in stroke patients. Nutr Clin Pract 2009; 24: 414-418
- 20 Nakagawa T, Wada H, Sekizawa K et al. Amantadin and pneumonia. Lancet 1999; 353: 1157
- 21 Petroianu G, Hein G, Petroianu A et al. Idiopathic chronic hic-up: combination therapy with cisapride, omeprazol, and baclofen. Clin Ther 1997; 19: 1031-1038
- 22 Petroianu G, Hein G, Stegmeier-Petroianu A et al. Gabapantin „add-on therapy“ for idiopathic chronic hiccup (ICH). J Clin Gastroenterol 2000; 30: 321-324
- 23 Prosiegel M. Neurogene Dysphagien. In: Diener HC, Putzki N, Hrsg. Leitlinien für die Diagnostik und Therapie in der Neurologie. 4.. Aufl. Stuttgart: Thieme; 2008: 908-919
- 24 Dennis MS, Lewis SC, Warlow C. and the FOOD Trial Cooperation. Effect of timing and method of enteral tube feeding for dysphasic patients (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365: 764-772
- 25 Smulders K, VanHoeven H, Weers-Pothoff I et al. A randomized controlled trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002; 121: 858-862
- 26 Brott T, Adams Jr HP, Olinger CP et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989; 20: 864-870
- 27 Kumar S, Doughty C, Doros G et al. Recovery of swallowing after dysphagic stroke: an analysis of prognostic factors. J Stroke Cerebrovasc Dis 2012; im Druck
- 28 Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30: 212-218
- 29 Smithard DG, O`Neill PA, England RE et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12: 188-193
- 30 Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006; 5: 31-37
- 31 Bath PM, Bath FJ, Smithard DJ. Interventions for dysphagia in acute stroke. Cochrane Library Oxford 2000; (2)
- 32 Shanahan TK, Logemann JA, Rademaker AW et al. Chin-down posture effect on aspiration in dysphagic stroke patients. Arch Phys Med Rehabil 1993; 74: 736-739
- 33 Logemann JA, Kahrilas PJ, Kobara M et al. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 1989; 70: 767-771
- 34 Lazarus C, Logemann JA, Song CW et al. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop 2002; 54: 171-176
- 35 Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia 1991; 6: 140-144
- 36 Ohmae Y, Logemann JA, Hanson DG et al. Effects of two breath-holding maneuvers on oropharyngeal swallow. Ann Otol Rhinol Laryngol 1996; 105: 123-131
- 37 Bartolome G. Grundlagen der funktionellen Dysphagietherapie (FDT). In: Bartolome G, Schröter-Morasch H, Hrsg. Schluckstörungen – Diagnostik und Rehabilitation. München, Jena: Urban & Fischer; 2010
- 38 Speyer R, Baijens L, Heijnen M et al. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia 2010; 25: 40-65
- 39 Shaker R, Easterling C, Kern M et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UOS opening. Gastroenterol 2002; 122: 1314-1321
- 40 Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior wall movement during deglutition. Am J Speech Lang Pathol 1996; 5: 23-30
- 41 Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow and chin tuck in healthy volunteers. Dysphagia 1999; 14: 67-72
- 42 Lazarra G, Lazarus C, Logemann JA. Impact of thermal stimulation on the triggering of the swallow reflex. Dysphagia 1986; 1: 73-77
- 43 Fraser C, Power M, Hamdy S et al. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Neuron 2002; 34: 831-840