Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke

  • Jalal Bakhtiyari Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
  • Payam Sarraf Iranian Center of Neurological Researches AND Department of Neurology, School of Medicine, Tehran University of Medical Sciences. Tehran, Iran
  • Noureddin Nakhostin-Ansari Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
  • Abbas Tafakhori Iranian Center of Neurological Researches AND Department of Neurology, School of Medicine, Tehran University of Medical Sciences. Tehran, Iran
  • Jeri Logemann Departments of Neurology and Otolaryngology-Head and Neck Surgery Feinberg, School of Medicine, Northwestern University, Evanston, IL
  • Soghrat Faghihzadeh Department of Biological Statistics and Epidemiology, School of Medicine, Zanjan University Medical Sciences, Zanjan, Iran
  • Mohammad Hossein Harirchian Mail Iranian Center of Neurological Researches AND Department of Neurology, School of Medicine, Tehran University of Medical Sciences. Tehran, Iran
Stroke, Dysphagia, Speech Therapy


Background: Dysphagia is common after stroke. The onset time of swallowing rehabilitation following stroke has an important role in the recovery of dysphagia and preventing of its complications, but it was either highly variable or was not stated in previous trials. The aim of this study was investigation effects of onset time of swallowing therapy on recovery from dysphagia following stroke.
Methods: Sixty dysphagia patients due to stroke range of age 60-74 (67.1 ± 3.8), participated in this randomized clinical trial study. The patients allocated in Early, Medium and Late groups, on the base of initiation of swallowing therapy after the stroke. After basic clinical and video fluoroscopic swallowing study assessments, traditional swallowing therapy was initiated 3 times per week for 3 months. The outcome measures were North-Western dysphagia patient check sheet, functional oral intake scale, video fluoroscopy, and frequency of pneumonia. Statistical analysis was done by repeated measure ANOVA, Bonferroni and χ2 tests.
Results: Three groups of patients in terms of demographic and clinical characteristics were similar in the pre-treatment P > 0.050. Onset time of swallowing therapy after stroke was effective on swallowing recovery on the main outcome variables. So that in first group patients, recovery was rather than other groups P < 0.050. Furthermore, the frequency of pneumonia in the early group was less than other groups and in the early group no patients experienced pneumonia P = 0.002.
Conclusion: Our data suggested that early interventions for dysphagia in stroke have an important role in recovery from dysphagia and prevention of complications like aspiration pneumonia.


1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36(12): 2756-63.
2. Smithard DG, O'Neill PA, England RE, Park CL, Wyatt R, Martin DF, et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12(4): 188-93.
3. Mann G, Hankey GJ, Cameron D.Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 2000; 10(5): 380-6.
4. Langdon C, Blacker D. Dysphagia in stroke:a new solution. Stroke Res Treat 2010;2010.
5. Seo HG, Oh BM, Han TR. Longitudinal changes of the swallowing process in subacute stroke patients with aspiration. Dysphagia 2011; 26(1): 41-8.
6. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006; 82(968):383-91.
7. Langdon PC, Lee AH, Binns CW. Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. J Clin Neurosci 2007; 14(7): 630-4.
8. Nilsson H, Ekberg O, Olsson R, Hindfelt B. Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients. Dysphagia 1998; 13(1):32-8.
9. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79(1): 14-9.
10.Teasell RW, Bach D, McRae M. Prevalence and recovery of aspiration poststroke: a retrospective analysis. Dysphagia 1994;9(1): 35-9.
11.Sellars C, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J, et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007; 38(8): 2284-91.
12.Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN. Aspiration following stroke: clinical correlates and outcome. Neurology 1988; 38(9): 1359-62.
13.Kedlaya D, Brandstater ME. Swallowing, nutrition, and hydration during acute stroke care. Top Stroke Rehabil 2002; 9(2): 23-38.
14.Vesey S. Dysphagia and quality of life. Br J Community Nurs 2013; Suppl: S14, S16, S18-S14, S16, S19.
15.Davis LA. Quality of Life Issues Related to Dysphagia. Topics in Geriatric Rehabilitation 2007; 23(4): 352-65.
16.Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia 2010; 25(1): 40-65.
17.Logemann JA. Evaluation and Treatment of Swallowing Disorders. London, UK: College-Hill Press; 1983.
18.Murry T, Carrau RL. Clinical Management of Swallowing Disorders. 3rd ed. San Diego, CA: Plural Pub; 2012.
19.Leonard R, Kendall K. Dysphagia Assessment and Treatment Planning: A Team Approach Dysphagia series. 2nd ed. San Diego, CA: Plural Publishing; 2007.
20.Huckabee ML, Pelletier CA. Management of Adult Neurogenic Dysphagia. San Diego, CA: Singular Publishing Group; 1999.
21.Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, et al. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. J Huazhong Univ Sci Technolog Med Sci 2011; 31(1): 73-6.
22.Kiger M, Brown CS, Watkins L. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia 2006; 21(4): 243-53.
23.Khedr EM, Abo-Elfetoh N. Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. J Neurol Neurosurg Psychiatry 2010; 81(5): 495-9.
24.Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006; 5(1): 31-7.
25.Takahata H, Tsutsumi K, Baba H, Nagata I, Yonekura M. Early intervention to promote oral feeding in patients with intracerebral hemorrhage: a retrospective cohort study. BMC Neurol 2011; 11: 6.
26.Hagg M, Larsson B. Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia. Dysphagia 2004; 19(4): 219-30.
27.Lin LC, Wang SC, Chen SH, Wang TG, Chen MY, Wu SC. Efficacy of swallowing training for residents following stroke. J Adv Nurs 2003; 44(5): 469-78.
28.-Mann GD, Crary MA. Adjunctive neuromuscular electrical stimulation for treatment-refractory dysphagia. Ann Otol Rhinol Laryngol 2008; 117(4): 279-87.
29.Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30(4): 744-8.
30.Terre R, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil 2006; 18(3): 200-5.
31.Splaingard ML, Hutchins B, Sulton LD, Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil 1988; 69(8): 637-40.
32. Robbins J, Butler SG, Daniels SK, Diez GR, Langmore S, Lazarus CL, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008; 51(1): S276-S300.
How to Cite
Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, Tafakhori A, Logemann J, Faghihzadeh S, Harirchian MH. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Curr J Neurol. 14(3):119-124.
Special Articles