Stroke and Dysphagia
Financial bid
Stroke
What is stroke?
 Stroke is a clinical event that results in cerebral
damage, affecting brain function
 There are 2 types of stroke:
 Ischaemic
 Haemorrahagic
 Stroke is the third leading cause of death and
disability
 At 75 years of age, 1 in 5 women and 1 in 6 men will
have a stroke
Consequences of stroke
 Approximately 1/3 of stroke survivors have
communication difficulties, including:
 Aphasia
 Dysarthria
 Apraxia
 Other consequences can include:
 Dysphagia
 Physical disability
 Changes in mood and personality
National Service Framework for
Stroke
 Overall aim: reduce incidence of stroke and provide
those who have had a stroke with prompt access to
integrated stroke care services.
 Four main components:
1) Prevention
2) Immediate care
3) Early and continuing rehabilitation
4) Long-term support
National Service Framework - for Older People (2002) pp. 70
SLT role within the care pathway
 SLTs are the only professionals qualified to diagnose, assess and provide a
programme of care to address these communication and swallowing needs.
 SLTs play a vital role at all stages along the care pathway. SLTs are the core
members of the team in the immediate care, and long-term rehabilitation of
stroke survivors.
 SLTs have a role in training other clinical staff to develop their skills needed
to understand the communication needs of stroke survivors.
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Dysphagia management
Communication disability management
Transfer of care to the community
Rehabilitation within the community
Completion of therapy and review
National Stroke Strategy (2007) :
Department of Health
 This was devised by six expert groups comprised of
representatives from the wide range of professionals who
support people with stroke, people who have had a stroke,
carers and voluntary associations.
 It’s intended to ‘provide a quality framework to secure
improvements to stroke services , to provide guidance and
support to commissioners and strategic health authorities
and social care, and inform the expectations of patients
and their families by providing a guide to high quality
health/social care services.
Stroke Strategy Action Plan
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Awareness
Preventing Stroke
Involvement
Acting on the warnings
Stroke as a medical emergency
Stroke unit quality
Rehabilitation and community support
Participation
Workforce
Service Improvement
Voluntary sector
 The Stroke Association services
can:
 Reduce hospital readmissions
 Shorten hospital stays
 Facilitate better integration of
care
 Save other statutory expenditure
 Meet current government
imperitives
 Meet the requirements of the
national stroke strategies across
the UK
Voluntary Sector
 Connect works with
individuals with aphasia
and their families
 They aim to develop
communication and
rebuild confidence
 Access to Life services
Voluntary Sector
 A clinical commissioner's guide to the voluntary sector
(Girach, Hardisty & Massey, 2012)
 Clinical Commissioners Groups that engage with the
voluntary sector can lead to:
 Better outcomes for people
 More cost effective use of NHS resources, generating
value for money
 Widening of the local provider base
NHS Annual Report
 The stroke pathway has developed significantly since 2010
 In 2013, it was awarded with a Level 1 accreditation
 Introduced regional network to allow specialist stroke
consultants to connect
 Thrombolysis available to suitable stroke patients 24 hours
a day
 Top performer in accural targets out of 21 stroke sites
 Consistently maintain targets for inpatient stay
 Identified areas to target to streamline stroke pathway and
reduce length of stay
 Aim for 2015 to implement improvements, allowing bed
reductions by improving patient discharge into community
and social care services as agreed and supported by the
Right First Time Programme
Dysphagia
What is dysphagia?
 Dysphagia is the medical term describing difficulty in
swallowing.
 Dysphagia can vary significantly in its severity and can
affect individuals of all ages.
 It may occur as a congenital or acquired condition.
 Dysphagia can be a transient, persistent or
deteriorating symptom according to the underlying
pathology.
Incidence/Prevalence of Dysphagia
Dysphagia Framework
 The national framework for dysphagia suggests: Treatment and care must include
 Vigilant observation and early management of possible
complications, such as chest infections, pneumonia
 A formal swallowing assessment and a plan for safe
hydration, feeding and medication.
 Early and continuing rehabilitation including SLT for
swallowing difficulties
 Specialist dysphagia services should provide training and
advise to all professions and service providers for
swallowing and nutritional needs
SLT role within the care pathway
 Acute Setting  SLT has key role in management of eating, drinking and
swallowing in hours and days after stroke.
 SLT intervention reduces occurrence of respiratory
infection and malnutrition whilst improving quality of life
and functional outcomes e.g. returning to work.
 Transfer to Community –
 Swallowing difficulties persist in 11% of patients 6 months
post-stroke.
 Pneumonia, pressure sores can be reduced with
appropriate SLT intervention
SLT role within the care pathway
 Rehab within community –
 SLT has role in continued management of patients with
persisting dyspagia
 Able to prevent further health conditions, unnecessary
readmission to hospital and reduce mortality rates.
 Recommendations –
 At least 1 SLT per 10 beds in every stroke unit (RCSLT, 2007)
 Staffing should be flexible and must address demographics
of area accounting for physical geography
 Flexible working hours incl. weekends can reduce referral
to treatment period (Sheffield Primary Care Trust)
What research is telling us
 Key points from RCSLT resource manual for commissioning
and planning services for SLCN (RCSLT, 2009)
 There is evidence that:
 Appropriate identification and management of dysphagia by
SLTs reduces morbidity, mortality and improves quality of life.
 Interventions used by SLTs in treatment of dysphagia are
effective.
 Appropriate management of dysphagia can reduce
complications and length of hospital stays.
What research is telling us
 Risk
 In 67% stroke patients, pneumonia manifests within 48hrs (Hassan
et al, 2006)
 Impact
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Difficulty swallowing caused anxiety at meal times. (Costa
Bandeira et al, 2008)
Elderly patients with dysphagia had significantly more frequent
chest pain, heart burn & regurgitation. (Tibbling & Gustafsson,
1991).
 Cost
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Length of stay in hospital longer for stroke patients with
dysphagia; patients with dysphagia twice as likely to be
discharged to nursing home. (Odderson et al, 1995).
What research is telling us
 Supporting timely and effective intervention:
 Hospital comparison study (Lucas & Rogers, 1998)
 Found hospital with SLT dysphagia service for inpatients
provided much higher standard of dysphagia treatment than
hospital with no SLT service.
 Bedside assessment review (Ramsey, Smithard & Kalra,
2003)
 Conclusion – more refinement of assessments needed to
improve accuracy
 Early swallow screen (Odderson, Keaton & McKenna, 1995)
 Completed within one day of admission, 39% patients failed
and needed dietary intervention.
Conclusion
 The SLT plays a vital role in the treatment of stroke and
dysphagia, including assessment, management, intervention and
training staff.
 The research supports the importance of early dysphagia
intervention, with effective and early initial swallow screening
reducing risk of aspiration pneumonia and consequently the
length and cost of hospital stays.
 It is more cost effective to invest in quality care at the beginning
of the pathway in order to obtain an early diagnosis and provide
effective treatment, both reducing costs and improving patients’
quality of life.
Thank you