**6. Dysphagia complications**

*Therapy Approaches in Neurological Disorders*

**Grading Description of respiratory tract, larynx, and trachea state**

1 Food does not pass into the respiratory tract.

of the respiratory tract.

respiratory tract.

respiratory tract.

respiratory tract.

weak to cough it up.

Pudding Penetration or aspiration without

Liquids Penetration or aspiration without

Solid food Penetration/aspiration with food

Solid food No penetration or aspiration, mild

*Fiberoptic endoscopic dysphagia severity scale (FEDSS).*

**dysphagia**

**Overall estimate 0 = no** 

*Overall estimate of dysphagia severity.*

Pudding Penetration/aspiration with

Liquids Penetration/aspiration with

or insufficient protective reflex

out of the larynx or respiratory tract.

out of the trachea despite the efforts.

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

or insufficient protective reflex

residues in the pyriform sinuses

residues of food in the sinuses

**1 = mild dysphagia**

sufficient protective reflex

sufficient protective reflex

**Main findings Grade Potential clinical consequences**

**2 = moderate dysphagia**

1 2 3 4 5 6 7 8

1 2 3 4 5 6

Grade 5 Tube feeding

Grade 4 Tube feeding with small portions

Grade 4 Tube feeding with small portions

Grade 2 Oral eating of pudding or liquids

Grade 1 Oral eating of semi-solid food or

**3 = severe dysphagia** **4 = very severe dysphagia**

Grade 3 Oral eating of pureed food

liquids

of pudding for oral eating during rehabilitation procedures

of pudding for oral eating during rehabilitation procedures

Saliva Penetration/aspiration Grade 6 No oral eating, only tube feeding

2 Food passes into the respiratory tract, staying above the vocal cords and it can be coughed out

5 Food passes into the respiratory tract, touches the vocal cords but cannot be pushed out of the

6 Food passes into the respiratory tract, it passes beneath the vocal cords and cannot be pushed

7 Food passes into the respiratory tract, it passes beneath the vocal cords and cannot be pushed

8 Food passes into the respiratory tract, it passes beneath the vocal cords, but a patient is too

3 Food passes into the respiratory tract, staying above the vocal cords but it cannot leave the

4 Food passes into the respiratory tract, touches the vocal cords, and is pushed out of the

**96**

**Table 4.**

Penetration-Aspiration Scale (PAS)

Endoscopic Dysphagia Severity

(FEDS)

**Table 5.**

**Table 3.**

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 complications of dysphagia [32].

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 complicate rehabilitation procedures [33].

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