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Abstract A cerebrovascular accident or stroke is a sudden loss of functions resulting from disruption of blood supply to a part of the brain. Stroke is the second leading cause of death worldwide. The effects of stroke regardless of its type whether thrombotic or hemorrhagic may vary from mild to severe disabilities, depending on the location of the lesion, the size of the area of inadequately perfused and the amount of collateral blood flow. The consequences of stroke are widespread and affect all body functions. One of the most common consequences is dysphagia. Dysphagia or difficulty in swallowing, affects up to 80 % of stroke victims. The complications of dysphagia are the most common causes of death for stroke patients. These complications are: malnutrition, dehydration and aspiration pneumonia. Deglutition or swallowing is a complex process which involves coordination of nerves and muscles to work efficiently together. This process is divided into 4 phases: oral preparatory phase, oral phase, pharyngeal phase and esophageal phase. Only the two first phases are under volitional control, however the third and fourth ones are nonvolitional. The whole process is governed by five cranial nerves: the trigeminal nerve, the facial nerve, the glossopharyngeal nerve, the vagus nerve and the hypoglossal nerve. The swallowing dysfunction of stroke patients occurs mainly in one andlor the three first phases of swallowing and is known as oropharyngeal dysphagia. The main management of dysphagia is rehabilitation which aims to reestablish safe oral feeding to a level that is as normal as possible. The components of the rehabilitation program comprise: dietary modification, postural changes of head and neck, swallowing techniques and oral motor exercises. Effective dysphagia rehabilitation requires a multidisciplinary team approach, in which the nurse is an integral member. The nurse is the first health team member to detect, assess signs and symptoms of dysphagia. Thus nurses have a crucial role in teaching safe feeding practices and reinforcing the compensatory strategies for successful rehabilitation program. The aim of this study was to determine the effectiveness of swallowing training on dysphagia following cerebrovascular stroke. The study was conducted at the neurological units of El-Hadara University Hospital and Gamal Abdel Naser Hospital. The study comprise 40 stroke patients who are oriented and conscious. Swallowing Assessment Sheet was developed to collect data, it cosisted of 5 parts: Part 1: Demographic and clinical data, Part 2: Swallowing Rating cale, Part 3: Testing of reflexes, Part 4: Testing of cranial nerves and Part 5: Oral motor assessment. A manual was developed by the researcher on compensatory postures. This was made available to the family member of the patients since they could be made to share in the assistance of the dysphagic patient to achieve safe swallowing. The program was implemented on four separated days in the presence of a patient’s family member. First day was geared for the assessment of the patient using the < Swallowing Assessment Sheet”, then the implementation of the training program began after completion of the assessment. Follow up of the patient was done in the 3rd, 6th and 9th day using part 2 of the Swallowing Assessment Sheet. The results of this study revealed that 45%of the patient were above 60 years old and 62.5% were male. Ninety two point five percent of the sample’s prescribed diet during their hospitalization was liquid. Regarding lip assessment, The majority of patients (87.5%) could stretch their lips, and 62.5% could close their lips. In relation to tongue assessment, symmetrical movement of tongue to the right side and left side was done by 30% of the patients respectively. As regards jaw, 62.5% of patients could not move their jaw to both sides. In relation to assessment of reflexes, 75% of patients had complete laryngeal elevation and 72.5% had intact gag reflex. Regarding voluntary cough, 62.5% had ineffective cough and only 37.5% had an effective cough. During the first observation of dysphagia manifestation, 57.5% of the patients had pocketing with potatoes and 62.5% had multiple swallow with the piece of biscuit. The majority of the studied patients (82.5%) had cough immediately after the swallow of water from a cup. As regards the third observation, only 2 patients coughed after swallowing a piece of biscuit, 10 patients with the sips of water and 5 patients with the teaspoon of water. Regarding patient’s swallowing level related to compensatory postures, in the first observation the ability of95% of patients related to swallowing of water from a cup was at L3, and 87.5% at the same level with swallowing a piece of biscuit but, more than half of the patients (60%) were at L 7 with custard. In the fourth observation, L 7 was reached by 74.3% and 75% of the patients respectively while eating biscuits and swallowing a teaspoon of water. In relation to swallowing water from a cup and eating a piece of biscuits still at L5 respectively by 21.1 % and 17.1 % of patients. As regards the relationship between patient’s age (above and below 50 years) and swallowing level, there is no statistical significant difference in relation to age and difficulty of swallowing each type of nutrient consistency. It was concluded from the results that the training program of swallowing for dysphagic patient poststroke is effective in improving patient swallowing in 9 days. The program proved the effectiveness of the compensatory postures and oral motor exercises for the patient. The most important recommendations were: Develop a written form of the bed side assessment sheet for each dysphagic patient to be used as a policy for assessing all stroke patients swallowing as soon as they are alert ,within 48 hours of admission and before giving any food or liquid orally. Use training program for the dysphagic patient and family members about dysphagia, management and complications Develop continuing inservice training programs for nurses who working in the neurological units about assessment of dysphagic patients, the compensatory postures and oral motor exercises to be carried out with dysphagic patients Develop a new nursing job title ”Dysphagia Nurse Specialist” who is trained and qualified in managing patient with dysphagia |