Impact of oral function on regaining oral intake and adjusting diet forms for acute stroke patients
Introduction
Dysphagia is a common consequence, with incidences reported up to 78% of stroke survivors.1 Consequently, it can lead to critical complications even in the acute stage, such as aspiration pneumonia and malnutrition.1, 2, 3, 4 Therefore, a thorough swallowing function assessment of each patient is necessary to provide an appropriate rehabilitation plan and nutrition support to prevent complications, maintain the nutrition status and facilitate an overall favorable outcome.
Numerous studies have described the importance of using clinical parameters as predictive factors for oral intake recovery in stroke patients to aid in patient management.5, 6, 7, 8, 9 They showed that several factors such as biographic data, stroke characteristics, comorbidities, laboratory or instrumental findings might help predict oral intake recovery. However, the conclusions amongst studies are inconsistent and mostly focused on general medical factors, only a few have included other possible factors, such as oral status.10, 11
Oral status is inevitably concerned when it comes to food intake. As acute stroke patients are likely to have declined and unstable oral health and function,12 it is essential to understand how it affects their oral intake recovery. For instance, tongue pressure measurement has been widely used to evaluate swallowing function in patients with various diseases.13, 14, 15, 16 It is considered a practical evaluation method when instrumental examinations are inaccessible.13, 17 Previous studies have also reported that reduced tongue pressure and movement might affect oropharyngeal dysphagia in stroke patients.14, 18 In addition, poor oral hygiene might be one of the risk factors for achieving complete oral intake.11 Furuya et al. also reported that tongue coating status and posterior occlusal support might influence the oral intake level of inpatients in acute care settings.10 Although there is existing evidence focused on oral status regarding eating ability; however, the knowledge of how the oral status of acute stroke patients associate with the probability of regaining complete oral intake is still limited. Therefore, this study aimed to explore the oral status-related factors that could predict the complete oral intake resumption in acute stroke patients during hospitalization. We hypothesized that oral function, particularly tongue pressure, could be useful indicators for predicting recovery of oral feeding.
Section snippets
Participants
Participants were recruited from patients admitted to Niigata University Medical & Dental Hospital and referred to the Dysphagia Rehabilitation Unit to evaluate their swallowing function between May 2017 and September 2021. The study was approved by the Ethics Committee of the Niigata University (2015-5080). Inclusion criteria: stroke diagnosis, presented with dysphagia signs and/or symptoms, had non-oral feeding at referral, age>18 years old. Exclusion criteria: coma stage (Japan Coma Scale
Patient characteristics
A total of 80 acute stroke patients with dysphagia were included in this study. Table 1 summarizes patients' general information. Patients received their first swallowing assessment within two weeks after stroke onset (average 4.53±6.71 days). At the first assessment, the number of patients who had FILS1, 2, and 3 were 65, 5, and 10, respectively. Thirty-three (41.25%) patients were on a nasogastric feeding tube, while 43 (53.75%) patients were on parenteral nutrition, and 4 (5.00%) patients
Discussion
This study focused on investigating the general function and oral status-related factors that could be useful to predict the possibility of regaining complete oral intake in acute stroke patients. The results indicated relevant clinical findings as follows. First, oral functions related factors, particularly tongue pressure, could be helpful to figure the probability of complete oral intake resumption during the acute stage. Second, besides dental conditions, other oral status-related factors
Conclusion
As for oral status-related factors, tongue pressure measurement, particularly at the posterior region, could be a practical and noninvasive bedside assessment tool for predicting complete oral intake recovery in acute stroke patients during hospitalization. At the same time, it could be another useful indicator for adjusting diet forms for patients who have regained oral intake ability. Furthermore, improvements in oral status-related factors also indicated the improvements of diet forms and
Authorship Criteria and Responsibilities
MI: conceived the design. SK, HS, MY, RT, and AS: collected the data. SK and MI: performed the literature review, analyzed the data, and collaboratively drafted the manuscript. KI, TT, and JM: revised the first draft. All authors approved the final version of the manuscript.
Disclosures
None
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