I was interested to read Dr David Campbell’s article on the SIGN guideline for the management of dysphagia in stroke patients (Guidelines in Practice, January 2005).

In our acute general hospital, as in many others, speech and language therapists fulfil the role of “professionals skilled in the management of dysphagia”. This involves using clinical bedside assessments and, where beneficial, instrumental swallow evaluations to advise on diet modification and feeding strategies. We also provide training packages on dysphagia for the multidisciplinary team.

The article emphasises the importance of instrumental assessments to assess swallowing in the acute stage of stroke. However, these methods have many limitations. They are unsuitable for considerable numbers of patients, who are unable to cope with the investigation procedure. Often, the resources are unavailable or limited.

When they are used, instrumental methods provide a ‘snapshot’ of swallow function. This is often of limited value in these patients whose swallow function can vary considerably during the course of the day and where dysphagia may be rapidly resolving.

Instrumental methods do have their benefits, but they tend to be for a small number of stroke patients in the acute stages. Comprehensive clinical bedside assessment and close multidisciplinary working are the key elements in effective management of dysphagia in the early stages following stroke.

Sarah Prewer,
Specialist Speech and Language Therapist (Acute Stroke and Dysphagia), Watford and Three Rivers PCT

Guidelines in Practice, February 2005, Volume 8(2)
© 2005 MGP Ltd
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