**5. Neurogenic dysphagia diagnoses and monitoring**

Dysphagia assessment procedures are selected depending on patient characteristics, severity of swallowing disorder, and procedure availability. Patients with stroke shall be screened for dysphagia during the first 24 hours after the disease onset and before oral eating [9, 23].

Swallowing assessment protocol was developed by the American Speech– Language–Hearing Association (ASHA). The main tests for oropharyngeal dysphagia assessment are the following ones:



### **Table 3.**

*Penetration-aspiration scale (PAS) developed according to Rosenbek criteria.*


### **Table 4.**

*Fiberoptic endoscopic dysphagia severity scale (FEDSS).*


**97**

*Dysphagia Associated with Neurological Disorders DOI: http://dx.doi.org/10.5772/intechopen.96165*

Dysphagia and protein-energy malnutrition, being predictors of bad functional recovery, are always associated with a high risk of medical complications. Weaning from mechanical ventilation of such patients is difficult. They have a high risk of purulent-septic complications. At the same time, a risk of sudden death increases [31]. Dysphagia complications are malnutrition, dehydration, weight loss, and respiratory tract obstruction. Aspiration pneumonia is one of the most important

When a stroke is complicated with dysphagia, malnutrition occurs 3 times more often than without it. The cases of protein-energy malnutrition in patients suffering a stroke vary from 7% to 15% at acute stage and from 22% to 35% after 2 weeks from the disease onset. Starvation or malnutrition associated with dysphagia activates catabolic processes. Among stroke patients requiring long rehabilitation period, malnutrition can amount to 50%. Malnutrition syndrome is risk factor of pneumonia. It increases sensitivity to oropharyngeal flora, leads to immunity suppression, reduces coughing strength, and affects wakefulness. All these factors

Aspiration is also one of the most dangerous complications of dysphagia. It leads to the respiratory tract obstruction, hypoxia, and aspiration pneumonia [34].

Neurogenic dysphagia treatment is provided in complex with primary disease treatment. Stroke patients need follow-up and treatment and rehabilitation procedures by multidisciplinary team, including nutritional support, exercises and physiotherapy, logopedic correction, pain control treatment, and psychological

Screening test shall always be conducted prior to patient feeding. Patient shall take oral medicines only in the presence or with assistance of medical staff. After taking medicines, a patient shall drink small portions of water. For this purpose, a patient shall be in a semi-sitting position or shall lie on a side with elevated chin; a risk of aspiration is lower in these positions. If even a mild swallowing disorder at pharyngeal phase is observed, it is required to act vice versa: to lower the chin. In this position, the tongue root is pushed backwards, and the epiglottis protective position is improved. This movement compensates for delayed initiation of pharyngeal swallow, as it narrows laryngeal inlet and prevents the bolus passing into the respiratory tract [36]. With nasogastric tube feeding, it is necessary to remember that long-period nasogastric feeding may cause such complications as nasopharyngitis, esophagitis, esophageal stricture, and nasopharynx edema. When dysphagia progression occurs or no swallowing function dynamics have been observed for a long period, a

Dysphagia patient management, depending on the level of consciousness, reasoned contact, use of a tracheostomy tube, and other factors, shall include the

• Swallowing screening test within 3 hours from the moment of admission;

• Examination of the oral cavity, teeth and gums, palpation of the regional

**6. Dysphagia complications**

complications of dysphagia [32].

complicate rehabilitation procedures [33].

correction [9, 15, 35].

gastrostomy tube is used [37].

• Medical history taking;

lymph nodes;

following actions related to examination: [38].

**7. Treatment and rehabilitation of dysphagia patients**

### **Table 5.**

*Overall estimate of dysphagia severity.*
