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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
INTRODUCTION
Stroke is a major cause of morbidity and mortality
all over the world. In the acute phase, it is
associated with the occurrence of medical
complications such as cardiac complications,
aspiration pneumonia, urinary tract infection, deep
vein thrombosis, pulmonary thromboembolism,
incontinence, depression, anxiety, pressure ulcers,
shoulder pain and dysphagia which further adds to
the miseries of patients and their families and
impairs clinical recovery(1–3). Dysphagia
following acute stroke is a common but often
under-diagnosed and under-recognized entity. The
incidence of dysphagia ranges from 19-81%(4-6)
and this wide range is possibly attributed to the
differences in the study design and the parameters
used for evaluation of dysphagia (4). In acute
stroke patients with dysphagia, there may be rapid
recovery during the first few days or it may remain
persistent at the time of discharge and up to 6
Profile of dysphagia in acute stroke: a prospecve observaonal study
from a terary care centre in Mumbai, India.
Mehul Desai
1
, Nirmal Surya
2
and Hitav Someshwar
3
1. DM resident, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India, 2. Hon. Consultant Neurologist,
Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India. 3. Assistant Professor, Physiotherapy School & Center,
Topiwala Naonal Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
ABSTRACT
Background and Objectives: Acute stroke is a leading cause of morbidity and mortality all around the world. Post-
stroke dysphagia is an important yet under-recognised complication occurring in the post-stroke period that may
result in undernutrition, dehydration, aspiration pneumonitis, and retard the recovery of the patient. Despite the
many path-breaking research in the management of stroke in the present era, post-stroke dysphagia remains a
neglected area of research. Materials and methods: In the current study, consecutive patients of acute stroke who
fulfilled inclusion criteria during hospitalization were evaluated for swallowing functions using a validated scale
with varying consistencies of food at the time of admission and discharge. We analysed different parameters to
evaluate swallowing functions following an acute stroke; incidence of post-stroke dysphagia, association between
stroke severity and dysphagia and lastly impact of the dysphagia on duration of hospital stay and healthcare
expenditure. Results: In our study, the incidence of dysphagia was 35% amongst all categories of acute stroke and
stroke severity at admission was a strong predictor for risk of post-stroke dysphagia. Patients with dysphagia had
higher average NIHSS scores as compared to patients without dysphagia. Despite the high incidence of dysphagia,
most of the patients recovered significantly at the time of discharge. Post-stroke dysphagia was associated with
extended duration of hospital stay and increased cost of healthcare as compared to patients without dysphagia.
Conclusion: Dysphagia is a common complication occurring in patients with acute stroke and is seen in patients
with increasing severity of stroke. Adequate screening of dysphagia and its management can help reduce
complications, reduce hospital stay and the economic burden to the patient.
KEYWORDS- Stroke, Dysphagia, Swallowing, Bed-side swallowing assessment.
CORRESPONDING AUTHOR
Dr. Nirmal Surya,
Hon. Consultant Neurologist,
Bombay Hospital and Medical Research Centre,
Mumbai, Maharashtra, India.
Email- nirmal_surya@gmail.com.
Received on- 1
st
March 2024
Published on- 13
th
July 2024
Clinical Profile of Dysphagia Post-Acute Stroke J Ind Fed NR
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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
months (7). If the normal swallowing does not
return by day-10 then significant recovery in
swallowing is unlikely to occur till 2-3 months (8).
Dysphagia following stroke predisposes the
patients to the risk of aspiration pneumonia,
malnutrition and adds significantly to morbidity,
mortality and increases the duration of hospital
stay, hence increasing overall healthcare
expenditure (9–11). While a significant proportion
of patients typically have obvious features of
aspiration such as coughing, choking while
swallowing etc; many times, patients may not have
any overt signs of aspiration – ‘silent
aspiration’(12). Management of acute stroke has
seen many advances and research in the last 2
decades including thrombolysis, mechanical
thrombectomy etc, however management of
dysphagia following stroke is a neglected area of
research. Dysphagia following stroke is a major
cause of pneumonia in this subgroup of patients and
dysphagia is associated with a 3-fold increase and
aspiration is associated with an 11-fold increase in
the risk of pneumonia (4).
Normal swallowing, a very smooth and
coordinated process, requires reflex and voluntary
control that involves smooth orchestration between
the nerves and muscles (13). Sound concept of the
normal physiology of swallowing is a pre-requisite
for understanding complex disorders related to
dysfunctional swallowing ‘dysphagia’! Normal
swallowing is divided into 3 phases: oral,
pharyngeal and oesophageal phase. The oral phase
is further subdivided into oral preparatory and
propulsive phases. During the oral-preparatory
phase, the bolus is processed into smaller pieces by
the process of chewing till it is optimal for
swallowing. During the next stage, processed food
bolus is propelled by the tongue to the oro-pharynx,
completing the first phase of swallowing. The
pharyngeal phase comprises rapid sequential
movement of food bolus from oro-pharynx to
oesophagus. Smooth sequential contraction of
pharyngeal muscles propels safe entry of bolus to
the oesophagus. This phase is integral in airway
protection by preventing entry of food bolus into
larynx. Interplay of several airway protective
mechanisms come into picture like closure of
glottis, elevation of hyoid and larynx as well as
backward tilt of epiglottis to seal laryngeal
vestibule. During the final phase of swallowing
food bolus enters stomach via peristaltic wave of
oesophageal muscles to complete the cycle of
swallowing (13–15). Swallowing is also intricately
linked to respiration such that breathing transiently
ceases while swallowing by two-fold mechanisms
of closure of airway by soft palate and neural
suppression of respiration.
Both hemispheric and brainstem strokes can affect
one or multiple aspects of normal physiology of
swallowing. (16–18)
1) Cerebral lesions cause impairment of neural
control of swallowing.
2) Lesion in primary motor cortex leads to
paresis of contralateral facial, lingual and buccal
musculature.
3) Lesions that affect and cause impairment of
attention and consciousness.
4) Impaired sensations from oral cavity in case
of brain-stem strokes, leading to disruption of
normal smooth process of swallowing.
5) Lower cranial nerve nuclear or fascicular
dysfunction
6) Oro-bucco-lingual apraxia.
Once the primary assessment and management of
acute stroke are taken care of, evaluation for
swallowing functions should be a priority and
preferably be done within first 24 hours. Early
detection of dysphagia and prompt intervention by
speech language pathologists can reduce incidence
of aspiration and pneumonia in patients with acute
stroke(19). Evaluation of dysphagia following
stroke can be done by either bedside swallowing
assessment (BSA) method or with instrumentation
supported procedures like videofluoroscopy (VFS)
and function endoscopic evaluation of swallowing
(FEES). In developing nations like India, where
cost and availability of such procedures preclude its
widespread utility, most centres rely on bedside
assessment for swallowing evaluation for
screening. Various studies have used different
screening tools ranging from simple patient-
oriented questionnaires to more refined scales like
Gugging swallowing screen (GUSS)(20–22). In
view of paucity of data from India, current study
was undertaken to identify profile of dysphagia, its
incidence, association between stroke severity,
Clinical Profile of Dysphagia Post-Acute Stroke J Ind Fed NR
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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
vascular territory and presence of dysphagia,
burden of dysphagia on healthcare expenses and
long-term morbidity and mortality.
METHODOLOGY
Study design- Prospective observational study.
The current study was conducted from 1st January
2019 to 31st December 2020 at a tertiary care
centre in Mumbai.
Inclusion criteria- We enrolled 100 consecutive
patients with acute stroke admitted at our centre
over a study period of 2 years. Those fulfilling
exclusion criteria were excluded from the study.
Exclusion criteria included patients with
mechanical dysphagia due to other causes. Patients
with residual dysphagia from previous strokes.
Patients with persistently obtunded state.
All the eligible patients were assessed for
swallowing functions using Nair Hospital Bed-side
Swallowing Assessment (NHBSA) and Nair
Hospital Swallowing Ability Scale (NHSAS)
within 24 hours of admission (23). Patients were re-
assessed once they were shifted out of ICU and at
the time of discharge. Those patients who
continued to have dysphagia on day-7 of
hospitalization were referred to the speech and
swallow clinic and FEES was performed.
TECHNIQUE
All the patients were initially tested in sitting
position with dry swallow testing, which once
found safe, were evaluated using varying
consistencies of food including thin liquids, thick
liquids and soft-solids.(Table 1) Once patients were
assessed with bedside evaluation, their dysphagia
was graded as per Nair hospital swallowing
assessment scale (NHSAS)(23) which is a 7-point
ordinal scale ranging from no dysphagia to slight,
mild, moderate, moderately severe, severe and
complete dysphagia.(23) Informed consent was
taken for everyone who participated in the study
and institutional ethics committee approval was
available.
RESULTS
Out of 100 patients in our study, 58 were males and
42 females. The average age of the patients during
our study was 62.3 years with an age range from
18-94 years. Out of 100 stroke patients, 86 had
ischemic stroke and 14 had haemorrhagic stroke.
(Figure 1) In the category of ischemic stroke, 78
patients had hemispheric strokes and 8
Table 1- Food trials for swallowing assessment
patients had brainstem strokes. Out of 78 patients
with hemispheric ischemic strokes 29 had
dysphagia during initial evaluation. (29/78 =
37.2%). (Figure 2) Out of 8 patients with brainstem
ischemic strokes 5 had dysphagia during early
evaluation. (5/8 = 62.5%). (Figure 3) During follow
up at the time of discharge, 12/78 patients with
acute ischemic hemispheric stroke had persistent
dysphagia while, 3/8 patients with brainstem acute
ischemic stroke had persistent dysphagia. To
summarise, 41% (12/29) of hemispheric and 60%
(3/5) of brainstem stroke patients with dysphagia at
the onset of stroke had persistent dysphagia at the
time of discharge. (Figure 4) Average duration of
hospitalization for patients with dysphagia was
8.53 +/- 2.93 days as compared to 4.52 +/- 0.87
days for patients with no dysphagia. (p<0.0001).
(Figure 5) Duration of hospital stay for patients
who had persistent dysphagia at time of discharge
was 11.25 +/- 2.17 days. (p < 0.002) Patients with
dysphagia had average NIHSS score of 12 +/- 3.77
as compared to patients without dysphagia who had
average NIHSS score of 4.75 +/- 1.81, p < 0.00001.
(Figure 6) Presence of dysphagia was associated
with average total healthcare cost of 96 thousand
INR as compared to those without dysphagia, in
whom average total healthcare expense was 67
thousand INR.
DISCUSSION
Dysphagia, ‘difficulty with swallowing’ is a
commonly encountered condition in patients with
acute stroke of various aetiologies and vascular
territories. Although data about prevalence and
Food trials for
swallowing
assessment
Thin liquid 5 ml water via spoon
Thick liquid 5 ml milk-biscuit mixture
via spoon
Soft solids Small pieces of biscuits
dipped in milk
Clinical Profile of Dysphagia Post-Acute Stroke J Ind Fed NR
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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
Figure 1- Prevalence of ischemic vs haemorrhagic
stroke in study population.
Figure 2- Prevalence of dysphagia amongst
patients with ischemic hemispheric stroke.
Figure 3- Prevalence of dysphagia amongst paents
with ischemic brainstem stroke.
Figure 4- Paents of hemispheric and brainstem stroke
with dysphagia on day-1 and at me of discharge.
Figure 5- Average duraon of hospital stay for paents
with and without dysphagia.
Figure 6- Paents with and without dysphagia and
their average NIHSS scores.
86
14
Acute Stroke patients (total
=100)
Ischemic stroke Haemorrhagic stroke
29(37.2%)
49(62.8%)
Dysphagia No Dysphagia
Ischemic hemispheric stroke
patients
Ischemic hemispheric stroke patients
5(62.5%)
3(37.5%)
Dysphagia No Dysphagia
Ischemic brainstem stroke
patients
Ischemic brainstem stroke patients
29
5
12
3
Hemispheric stroke Brainstem strokes
Dysphagia at the time of
admission and discharge
Dysphagia on Day-1 Dysphagia at time of discharge
8.53 days
4.52 days
Dysphagia No dysphagia
Duration of hospital stay
Duration of hospital stay
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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
profile of dysphagia is abundant from western
world, similar large-scale studies from India are
rather sparse. In current study, we try to find
answers to many of such unresolved questions
about dysphagia in patients with acute stroke in the
Indian context.
In our study, in which we enrolled consecutive 100
patients of acute stroke from a tertiary care centre
in Mumbai, males and females were respectively
58 and 42 in numbers. Average age of patients with
acute stroke in current study was 62.3 years with
age range of 18 to 94 years.
Ischemic strokes were more common than
haemorrhagic strokes in our study. Out of 100
patients with acute stroke, 86 had ischemic stroke,
while 14 had haemorrhagic stroke. In our study
hemispheric strokes were more prevalent as
compared to brainstem strokes in patients with
acute ischemic strokes. Among 86 patients with
ischemic stroke, 78 had hemispheric stroke and 8
had brainstem stroke. Swallowing function was
assessed using validated NHBSA and NHSAS
questionnaire, and the overall incidence of
dysphagia in patients of acute stroke was 35%
including both ischemic and haemorrhagic strokes.
Prevalence of dysphagia has had wide range from
19-81 %(4–6) across various studies given the
myriad bedside swallowing screening tools,
different definitions of dysphagia used and
differences in the timing of screening for
dysphagia.
During current study, we found that 29 out of 78
patients (37.17%) with hemispheric ischemic
stroke had dysphagia during first evaluation
performed within first 24 hours, while 5 out of 8
patients (62.5%) with brainstem ischemic stroke
had dysphagia on first evaluation.
We re-evaluated all the patients at the time of
discharge to identify those who continued to have
dysphagia even at the time of discharge. 12 of 29
patients with ischemic hemispheric stroke had
persistent dysphagia at the time of discharge, while
3 of 5 patients with brainstem ischemic stroke had
persistent dysphagia. Overall prevalence of
dysphagia at the time of admission and discharge
was higher in patients with brainstem strokes,
however due to a smaller number of patients with
brainstem strokes, statistical significance of this
finding could not be established. Various studies
have shown contradictory results regarding
whether brainstem strokes are associated with
dysphagia more frequently at the time of admission
and discharge. Brainstem lesions are known to
impair oro-pharyngeal sensations, interfere with
elevation of larynx and cause lower cranial nuclear
/ fascicular palsies which significantly predispose
the patient to impaired swallowing mechanisms
and result in dysphagia. On the contrary
hemispheric lesions impairs normal swallowing by
interfering with process of motor planning and
execution of swallowing, impaired cognition,
neglect, and apraxia (16–18).
One of the strong determinants of dysphagia risk
was stroke severity at the time of admission. One
study showed that NIHSS, Glasgow come scale
and speech/language changes were positively
associated with dysphagia risk during the
immediate post-stroke period. In our study severity
of stroke as determined by NIHSS was a strong risk
factor for dysphagia which is consistent with
results from previous studies (24,25). Patients with
dysphagia had an average NIHSS scores of 12 +/-
3.87 as compared to patients without dysphagia
who had average NIHSS scores of 4.75 +/- 1.171,
p < 0.0001. Our study substantiated the findings of
earlier studies with regards to severity of stroke at
admission being one of the chief predictors of
dysphagia risk.
Former studies have highlighted the impact of
dysphagia on overall duration of hospital stay,
increasing morbidity, mortality and healthcare
expenditure to the patients with acute stroke(9,10).
Our study corroborated these findings and provide
invaluable insight into the excessive burden that
dysphagia can put on patients and their families in
a resource-limited settings like India. Average
duration of hospitalization for patients with acute
stroke without dysphagia was 4.52 +/- 0.87 days,
while for patients with dysphagia it was 8.53 +/-
2.93 days. To add on to this, patients who had
persistent dysphagia at the time of discharge had
overall longer duration of hospital stay (11.25 +/-
2.17 days) as compared to those who had no
dysphagia at the time of discharge (8.53 +/- 2.93
days).Similarly, patients with dysphagia, because
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Mehul Desai et al. Journal IFNR Volume 1, Issue 1
of their extended hospital stay and risks of other
medical complications during prolonged hospital
stay have higher hospital expenses as compared to
acute stroke patients without dysphagia. In our
study, patients with dysphagia had an overall
average hospital expense of 96 thousand INR as
compared to average expense of 67 thousand INR
for patients without dysphagia. A study from a
tertiary care centre of India reported similar
findings with average care of acute stroke patients
costing 89 thousand INR per patient (26). In a
country like India where awareness about stroke
and its complications remains low, majority of
population still belongs to lower socio-economic
strata with no facility of health-care insurance,
dysphagia can put patients and their families under
excess financial burden, only to add to their agonies
of dealing with disability inflicted by acute stroke
and its complications. Early detection of dysphagia
by comprehensive cost-effective bedside screening
tools can help us identify at-risk patients of
dysphagia during immediate post-stroke period in
very early stages. Early and effective interventions
with the help of speech language pathologists can
help us prevent many of the medical complications
secondary to dysphagia and reduce overall
morbidity and mortality of patients with acute
stroke.
LIMITATIONS OF THE STUDY
Although our study provides many captivating
aspects related to the profile of dysphagia from a
developing nation like India in patients with acute
stroke, which can provide us with early
opportunities to intervene and reduce rates of many
medical complications, we observed that one major
limitation of our study was our inability to assess
patients with severe stroke who were in the
obtunded state at the time of first assessment. Such
patients are likely to have high NIHSS scores and
increased rates of complications, morbidity and
mortality during follow up. We wanted to follow up
patients for up to 6 months but due to sudden
emergence of Covid pandemic, many patients were
lost to follow-up, which we feel is another major
limitation of our study(27). We would like to design
future studies to follow up such patients for
minimum up-to 6 months to give us a more
complete picture.
CONCLUSION
Acute stroke represents one of the major causes of
morbidity and mortality. Post-stroke dysphagia
although a common but under-diagnosed entity,
can affect many dimensions of acute stroke-care.
Stroke severity measured by NIHSS remains one of
the chief predictors of post-stroke dysphagia risk
and post-stroke dysphagia is associated with
increased duration of hospital stay and health care
expenses. Early detection of dysphagia and timely
intervention can likely result in rapid recovery of
swallowing functions, early discharge from
hospital and reduced rate of secondary
complications due to prolonged hospital stay;
however larger case studies will be required.
REFERENCES
1. Kumar S, Selim MH, Caplan LR. Medical
complications after stroke. The Lancet
Neurology. 2010 Jan;9(1):105–18.
2. Langhorne P, Stott DJ, Robertson L,
MacDonald J, Jones L, McAlpine C, et al.
Medical complications after stroke: a
multicenter study. Stroke [Internet]. 2000 [cited
2022 Jan 4];31(6):1223–9. Available from:
https://pubmed.ncbi.nlm.nih.gov/10835436/
3. Indredavik B, Rohweder G, Naalsund E,
Lydersen S. Medical complications in a
comprehensive stroke unit and an early
supported discharge service. Stroke [Internet].
2008 Feb [cited 2022 Jan 4];39(2):414–20.
Available from:
https://pubmed.ncbi.nlm.nih.gov/18096834/
4. Martino R, Foley N, Bhogal S, Diamant N,
Speechley M, Teasell R. Dysphagia after
stroke: Incidence, diagnosis, and pulmonary
complications. Stroke. 2005 Dec;36(12):2756–
63.
5. Nilsson H, Ekberg O, Olsson R, Hindfelt B.
Dysphagia in stroke: a prospective study of
quantitative aspects of swallowing in dysphagic
patients. Dysphagia [Internet]. 1998 [cited
2022 Jan 4];13(1):32–8. Available from:
https://pubmed.ncbi.nlm.nih.gov/9391228/
6. Kidd D, Lawson J, RN-QA international, 1995
undefined. The natural history and clinical
consequences of aspiration in acute stroke.
academic.oup.com [Internet]. [cited 2022 Jan
4]; Available from:
Clinical Profile of Dysphagia Post-Acute Stroke J Ind Fed NR
Page | 9
Mehul Desai et al. Journal IFNR Volume 1, Issue 1
https://academic.oup.com/qjmed/article-
abstract/88/6/409/1560065
7. Mann G, Hankey GJ, Cameron D. Swallowing
Disorders following Acute Stroke: Prevalence
and Diagnostic Accuracy. Cerebrovascular
Diseases. 2000;10(5):380–6.
8. Mann G, Hankey GJ, Cameron D. Swallowing
function after stroke: prognosis and prognostic
factors at 6 months. Stroke [Internet]. 1999
[cited 2022 Jan 11];30(4):744–8. Available
from:
https://pubmed.ncbi.nlm.nih.gov/10187872/
9. Bonilha HS, Simpson AN, Ellis C, Mauldin P,
Martin-Harris B, Simpson K. The One-Year
Attributable Cost of Post-stroke Dysphagia.
Dysphagia 2014 29:5 [Internet]. 2014 Jun 20
[cited 2022 Jan 4];29(5):545–52. Available
from:
https://link.springer.com/article/10.1007/s0045
5-014-9543-8
10. Broadley S, Croser D, Cottrell J, Creevy M,
Teo E, Yiu D, et al. Predictors of prolonged
dysphagia following acute stroke. Journal of
Clinical Neuroscience [Internet]. 2003 May 1
[cited 2022 Jan 4];10(3):300–5. Available
from: http://www.jocn-
journal.com/article/S0967586803000225/fullte
xt
11. Li L, Zhang L, Xu W, Hu J. Risk assessment of
ischemic stroke associated pneumonia. World
journal of emergency medicine [Internet]. 2014
[cited 2022 Jan 4];5(3):209. Available from:
https://pubmed.ncbi.nlm.nih.gov/25225586/
12. Leder SB, Cohn SM, Moller BA. Fiberoptic
Endoscopic Documentation of the High
Incidence of Aspiration following Extubation
in Critically Ill Trauma Patients. Dysphagia.
1998 Aug;13(4):208–12.
13. Matsuo K, Palmer JB. Anatomy and
Physiology of Feeding and Swallowing:
Normal and Abnormal. Physical Medicine and
Rehabilitation Clinics of North America. 2008
Nov 1;19(4):691–707.
14. Dodds WJ, Stewart ET, Logemann JA.
Physiology and radiology of the normal oral
and pharyngeal phases of swallowing. AJR
American journal of roentgenology [Internet].
1990 [cited 2022 Jan 4];154(5):953–63.
Available from:
https://pubmed.ncbi.nlm.nih.gov/2108569/
15. Normal and Abnormal Swallowing. Normal
and Abnormal Swallowing. 2003;
16. Plant RL. Anatomy and physiology of
swallowing in adults and geriatrics.
Otolaryngologic Clinics of North America.
1998;31(3):477–88.
17. Yun YJ, Na YJ, Han SH. Swallowing apraxia
in a patient with recurrent ischemic strokes: A
case report. Medicine (United States). 2019 Sep
1;98(39).
18. Robbins JA, Levine RL. Swallowing after
unilateral stroke of the cerebral cortex:
preliminary experience. Dysphagia [Internet].
1988 Mar [cited 2022 Jan 3];3(1):11–7.
Available from:
https://pubmed.ncbi.nlm.nih.gov/3248391/
19. Antonios N, Carnaby-Mann G, Crary M, Miller
L, Hubbard H, Hood K, et al. Analysis of a
physician tool for evaluating dysphagia on an
inpatient stroke unit: the modified Mann
Assessment of Swallowing Ability. Journal of
stroke and cerebrovascular diseases : the
official journal of National Stroke Association
[Internet]. 2010 Jan [cited 2022 Jan
4];19(1):49–57. Available from:
https://pubmed.ncbi.nlm.nih.gov/20123227/
20. Trapl M, Enderle P, Nowotny M, Teuschl Y,
Matz K, Dachenhausen A, et al. Dysphagia
bedside screening for acute-stroke patients: The
gugging swallowing screen. Stroke [Internet].
2007 Nov 1 [cited 2022 Jan 4];38(11):2948–52.
Available from:
https://www.ahajournals.org/doi/abs/10.1161/
STROKEAHA.107.483933
21. Perry L, Love CP. Screening for dysphagia and
aspiration in acute stroke: a systematic review.
Dysphagia [Internet]. 2001 [cited 2022 Jan
4];16(1):7–18. Available from:
https://pubmed.ncbi.nlm.nih.gov/11213249/
22. Ramsey DJC, Smithard DG, Kalra L. Early
assessments of dysphagia and aspiration risk in
acute stroke patients. Stroke. 2003 May
1;34(5):1252–7.
23. Babani N, Hattiangadi G. Bedside assessment
protocol and grading scale for dysphagia in
adults: A preliminary study. Journal of Indian
Clinical Profile of Dysphagia Post-Acute Stroke J Ind Fed NR
Page | 10
Mehul Desai et al. Journal IFNR Volume 1, Issue 1
Speech Language and Hearing Association.
2014;28(1):10.
24. Paciaroni M, Mazzotta G, Corea F, Caso V,
Venti M, Milia P, et al. Dysphagia following
Stroke. European Neurology [Internet]. 2004
[cited 2022 Jan 4];51(3):162–7. Available
from:
https://www.karger.com/Article/FullText/7766
3
25. Okubo PCMI, Fábio SRC, Domenis DR,
Takayanagui OM. Using the National Institute
of Health Stroke Scale to Predict Dysphagia in
Acute Ischemic Stroke. Cerebrovascular
Diseases. 2012;33(6):501–7.
26. Agrawal K, Surya N, Someshwar H. The Care
And Cost of Acute Ischemic Stroke in a Stroke
Unit of a Tertiary Care Hospital in Mumbai.
2020 Jan 30;3:3–4.
27. Bhatia R, Sylaja PN, Padma Srivastava MV,
Khurana D, Pandian J, Suri V, et al. Consensus
Statement - Suggested Recommendations for
Acute Stroke Management during the COVID-
19 Pandemic: Expert Group on Behalf of the
Indian Stroke Association. Annals of Indian
Academy of Neurology. 2020;0(0):0.
CITE THIS ARTICLE:
Desai M, Surya N, Someshwar H, Profile of dysphagia
in acute stroke: a prospecve observaonal study
from a terary care centre in Mumbai, India.
J Ind Fed NR, 2024, Aug 2024; 1 (1): 3-10
