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Post-stroke dysphagia: novel treatment approaches

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The paper presents the results of examination and treatment in patients in the early recovery period of ischemic stroke. It considers the concurrent use of drug and speech therapies to improve the rehabilitation of patients with post-stroke speech and swallowing disorders.

Objective: to identify the role of speech-language therapy and neuropsychology sessions in the treatment of speech and swallowing disorders in the early recovery period of ischemic hemispheric stroke.

Patients and methods. A total of 45 patients (32 (71%) men and 13 (29%) women) with a 2–3-month history of ischemic hemispheric stroke were examined. The follow-up period was 2 months. The patients were divided in two groups. Group 1 (a study group) included 30 patients who received combination therapy (drug treatment; sessions with a speech-language pathologist; and compensatory treatments for restoring swallowing function). All the patients had moderate dysphagia accompanied by speech disorders. Moderate sensorimotor aphasia was observed in 15 patients; moderate dysarthria was also seen in 15 patients. Vinpocetine (Cavinton®) and its dispersible tablets (Cavinton® Comfort) were chosen as an agent for vasoactive therapy. Group 2 (a comparison group) consisted of 15 patients with dysphagia who had only standard therapy and speech therapy sessions. There was sensorimotor aphasia in 2 (4%) patients and dysarthria in 13 (29%). A complex psychological and logopedic examination was carried out using the Mann Assessment of Swallowing Ability (MASA), dysarthria assessment, and the scale designed by L.I. Vasserman for estimating the degree of speech disorders in patients with local brain injuries.

Results and discussion. Posttreatment swallowing function improved in all the 45 patients; however, more pronounced positive changes were recorded in the patients of Group 1 (p< 0.05). Survey data, possible diet modification, better patient communications, improved quality of life in the patients, and the opinions of their relatives and medical staff served as criteria for the effectiveness of the model used to recover swallowing function. A subjective improvement showed itself as an increased ability to initialize the pharyngeal phase of swallowing in 25 (56%) patients and none mild delays (up to 5 sec) in the movement of a food bolus in the oral cavity in 10 (22%) patients and in the intake of the food of different consistency in 10 (22%). After a treatment cycle in Group 1, the number of patients with mild dysphagia increased up to 30%; moderate swallowing disorders were present in 63% of patients, which required that medical and speech correction should be continued. A significant improvement in swallowing function was noted in 10% of Group 1 patients with medium-sized cortical and cortical-subcortical lesions; a moderate improvement was seen in 67% with medium and small cerebral foci at the same location. At the same time, in Group 2 there were insignificant positive changes only in 20% of patients, most of whom had dysarthria.

Conclusion. The high incidence of post-stroke makes it reasonable to use speech therapy methods in a set of multidisciplinary specialized types of care. This care should be personalized; prescribing easy-to-swallow dispersible drugs plays an important role in this case. This will improve quality of life in the patient and protect him from unwanted complications. 

About the Authors

M. M. Tanashyan
Research Center of Neurology
Russian Federation

80, Volokolamskoe Shosse, Moscow 125367

E. S. Berdnikovich
Research Center of Neurology
Russian Federation

80, Volokolamskoe Shosse, Moscow 125367

O. V. Lagoda
Research Center of Neurology
Russian Federation

Contact: Olga Viktorovna Lagoda 

80, Volokolamskoe Shosse, Moscow 125367


1. Piradov MA, Illarioshkin SN, Tanashyan MM, editors. Nevrologiya XXI veka: diagnosticheskie, lechebnye i issledovatel'skie tekhnologii. Rukovodstvo dlya vrachei [Neurology of the XXI century: diagnostic, therapeutic and research technologies. A guide for physicians]. Moscow: ATMO; 2015. 1240 p.

2. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet Neurol. 2016 Aug; 15(9):913-924. doi: 10.1016/S1474-4422(16)30073-4. Epub 2016 Jun 9.

3. Stakhovskaya LV, Klochikhina OA, Bogatyreva MD, Kovalenko VV. Epidemiology of stroke in Russia according to the results of the territorial-population registry (2009–2010). Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2013;113(5): 4-10. (In Russ.).

4. Kadykov AS, Shakhparonova NV. Lechenie i reabilitatsiya bol'nykh v vosstanovitel'nom rezidual'nom periodе insul'ta [Treatment and rehabilitation of patients in the recovery residual periods of stroke. Moscow; 2014. 93 p.

5. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999 Apr;30(4):744-8.

6. Baroni AF, Fä bio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol. 2012 Apr-Jun;49(2):118-24.

7. Terre R, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil. 2006 Mar;18(3):200-5.

8. Luria AR. The functional organization of the brain. Sci Am. 1970 Mar;222(3):66-72 passim.

9. Stakhovskaya LV, editor. Klinicheskie rekomendatsii po vedeniyu bol'nykh s ishemicheskim insul'tom i tranzitornymi ishemicheskimi atakami [Clinical guidelines for management of patients with ischemic stroke and transient ischemic attacks]. Moscow; 2017. 208 p.

10. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke. A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947. doi: 10.1161/STR.0b013e318284056a. Epub 2013 Jan 31.

11. Piradov MA, Tanashyan MM, Domashenko MA. Neuroprotection in cerebrovascular diseases: the search for life on Mars or a promising direction of treatment. Part 1. Acute disorders of cerebral circulation. Annaly klinicheskoi i eksperimental'noi nevrologii. 2015;9(1):41–50. (In Russ.).

12. Piradov MA, Tanashyan MM, Domashenko MA, Maksimova MYu. Neuroprotection in cerebrovascular diseases: the search for life on Mars or a promising direction of treatment. Part 2. Chronic forms of cerebral circulation disorders. Annaly klinicheskoi i eksperimental'noi nevrologii. 2015;9(3):10-9. (In Russ.).

13. Suslina ZA, Tanashyan MM, Ionova VG, et al. Cavinton in the treatment of patients with ischemic cerebrovascular disease-new aspects of the action. Lechenie nervnykh boleznei. 2002;3(3):19-24. (In Russ.).

14. Suslina ZA, Tanashyan MM, Maksimova MYu, et al. Cavinton (Vinpocetine) in the treatment of patients with acute and chronic forms of vascular diseases of the brain: new aspects of therapy. Farmateka. 2004;(14):99-104. (In Russ.).

15. Tanashyan MM, Lagoda OV, Fedin PA, et al. Modern approaches to treatment of patients with chronic vascular diseases of the brain. Nervnye bolezni. 2010;(4): 19-22. (In Russ.).

16. Zhivolupov SA, Samartsev IN, Yakovlev EV, et al. Evaluation of the efficacy of Vinpocetine (Cavinton Comforte) in the treatment of dizziness in patients with dyscirculatory encephalopathy by the level of neurotrophic factor of the brain (BDNF) in blood plasma. Klinicheskaya farmakologiya i terapiya. 2016;25(1):49-54. (In Russ.).

17. Tanashyan MM, Lagoda OV, Antonova KV, Konovalov RN. Chronic cerebrovascular diseases and metabolic syndrome: approaches to pathogenetic therapy of cognitive disorders. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. 2016;116(9):106–10. (In Russ.).

For citation:

Tanashyan M.M., Berdnikovich E.S., Lagoda O.V. Post-stroke dysphagia: novel treatment approaches. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(2):57-62. (In Russ.)

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)