الفهرس 
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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