Parker Claire, Power Maxine, Hamdy Shaheen, Bowen Audrey, Tyrrell Pippa, Thompson David G
Speech and Language Therapy Department, Hope Hospital, Salford, Manchester, UK.
Dysphagia. 2004 Winter;19(1):28-35. doi: 10.1007/s00455-003-0032-8.
Patients' awareness of their disability after stroke represents an important aspect of functional recovery. Our study aimed to assess whether patient awareness of the clinical indicators of dysphagia, used routinely in clinical assessment, related to an appreciation of "a swallowing problem" and how this awareness influenced swallowing performance and outcome in dysphagic stroke patients. Seventy patients were studied 72 h post hemispheric stroke. Patients were screened for dysphagia by clinical assessment, followed by a timed water swallow test to examine swallowing performance. Patient awareness of dysphagia and its significance were determined by detailed question-based assessment. Medical records were examined at three months. Dysphagia was identified in 27 patients, 16 of whom had poor awareness of their dysphagic symptoms. Dysphagic patients with poor awareness drank water more quickly (5 ml/s vs. <1 ml/s, p = 0.03) and took larger volumes per swallow (10 ml vs. 6 ml, p = 0.04) than patients with good awareness. By comparison, neither patients with good awareness or poor awareness perceived they had a swallowing problem. Patients with poor awareness experienced numerically more complications at three months. Stroke patients with good awareness of the clinical indicators of dysphagia modify the way they drink by taking smaller volumes per swallow and drink more slowly than those with poor awareness. Dysphagic stroke patients, regardless of good or poor awareness of the clinical indicators of dysphagia, rarely perceive they have a swallowing problem. These findings may have implications for longer-term outcome, patient compliance, and treatment of dysphagia after stroke.
中风后患者对自身残疾的认知是功能恢复的一个重要方面。我们的研究旨在评估临床评估中常规使用的吞咽困难临床指标的患者认知是否与对“吞咽问题”的认识相关，以及这种认知如何影响吞咽困难中风患者的吞咽表现和结局。对70例半球性中风后72小时的患者进行了研究。通过临床评估对患者进行吞咽困难筛查，随后进行定时水吞咽试验以检查吞咽表现。通过详细的基于问题的评估确定患者对吞咽困难及其重要性的认知。在三个月时检查医疗记录。27例患者被确诊为吞咽困难，其中16例对其吞咽困难症状的认知较差。与认知良好的患者相比，认知较差的吞咽困难患者喝水速度更快（5毫升/秒对<1毫升/秒，p = 0.03），每次吞咽量更大（10毫升对6毫升，p = 0.04）。相比之下，认知良好或认知较差 的患者都没有意识到自己有吞咽问题。认知较差的患者在三个月时出现的并发症在数量上更多。对吞咽困难临床指标认知良好的中风患者会改变他们的饮水方式，每次吞咽量更小，饮水速度比认知较差的患者更慢。吞咽困难的中风患者，无论对吞咽困难临床指标的认知良好与否，很少意识到自己有吞咽问题。这些发现可能对中风后吞咽困难的长期结局、患者依从性和治疗有影响。
