الفهرس 
Dysphagia definition and C ausesOnly 14 pages are availabe for public view
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Abstract
Dysphagia is one of the most common morbidities after stroke, with a reported incidence of 29%-81%. Post-stroke dysphagia increases the risk for dehydration, malnutrition, pulmonary complications, and mortality, all of which lead to a poor prognosis.
Managing dysphagia early in the stroke care pathway is of international concern, and so worldwide clinical guidelines mandate systematic bedside swallowing screening within the first few hours of admission to the hospital and prior to offering any oral food, fluid, or medication.
Gugging Swallowing Screen (GUSS) is one of the swallowing screening tests that have been validated in patients with acute stroke and has been recently recommended to be considered for regular clinical application in patients with stroke who are suspected of being at risk of aspiration.
FEES is used to identify pathological movement patterns, to assess the effectiveness and safety of swallowing, to determine suitable food consistencies or forms of nutrition and to guide the use of therapeutic manoeuvres for each patient.
Modification of food and fluids appears to reduce aspiration in some circumstanc¬es by slowing transit times and reducing chewing. Also, early mobilization and regular active turning can reduce the risk of pneumo¬nia in stroke patients. Stimulation of the pharyn¬geal structures does appear to trigger an increase in swallow activity, but it is unclear how long this lasts and whether it results in better outcomes.
Interventional rehabilitation has played a significant role in management of dysphagia. Non-invasive brain stimulation could be used as a treatment to rehabilitate dysphagia commonly consisting of transcranial magnetic stimulation (TMS), transcranial direct-current stimulation (tDCS), as well as paired associative stimulation (PAS), has attracted increased interest and been applied experimentally in the treatment of post-stroke dysphagia. Pharyngeal electrical stimulation (PES) has been shown to induce cortical changes in areas known to be important in swallowing function.
Our study aimed to assess the efficacy of (tDCS) and TENS combined on management of dysphagia in acute stroke guided by Fiber-optic endoscopic evaluation of swallowing (FEES).
48 patients were enrolled in this study, all of them diagnosed as acute cerebrovascular stroke associated with dysphagia. All patients were assessed for dysphagia using GUSS test and FEES. Patients are divided into 3 groups, 16 patients in each group of total 48.
The first group received tDCS /TENS active, the second group received TENS active and the third group received (sham) TENS.
The three groups were compared for their scores on GUSS test. Significant improvement was seen in all subtypes of GUSS test in tDCS/TENS group. However, in other two groups, there was only improvement in GUSS test regarding safety in liquid swallowing.
TENS sham was effective regarding safety of liquid swallowing only which could be explained by placebo effect or spontaneous improvement of dysphagia.
However, in comparison between 3 groups, there was no significant difference in results of dysphagia management.