Early Rehabilitation to Prevent Pneumonia in Oropharyngeal Dysphagia Poststroke: A 6-Month Follow-Up Study

Objective: To determine whether early rehabilitation treatment influences the incidence of pneumonia and swallowing recovery time in poststroke patients with oropharyngeal dysphagia. Design: A prospective case series with a 6-month follow-up. Setting: Acute stroke unit and rehabilitation department. Participants: 62 consecutively admitted stroke patients with oropharyngeal dysphagia, with sufficient cognition to participate in rehabilitation training (with a Mini-Mental State Examination score ≥21). 48 patients (28 men, 20 women; average age, 73.1±11.0y) completed the trial. Interventions: Swallowing function was evaluated through bedside and fiberoptic endoscopic evaluation of swallowing (FEES) at the start of rehabilitation and at 6-month follow-up. Rehabilitation treatment, starting 5.3±3.2 days after stroke (average, 12.2 sessions, lasting about 1h, 4×/wk), included oral motor exercises and breathing coordination, procedures to increase oropharyngeal sensory input, different postural techniques to obtain safer swallowing, and dietary modifications. Main Outcome Measures: Pneumonia episodes and restart of oral feeding. Results: 30 patients showed aspiration at first FEES (time poststroke, 6.2±3.9d) but only 5 showed aspiration at the 6-month evaluation. After the 6-month follow-up, 4 (8.3 %) of 48 patients had suffered pneumonia. There was no significant relationship between the appearance of pneumonia and sex, stroke side (left, right), type of lesion (ischemic, hemorrhagic), and other clinical variables (abnormal volitional cough, dysphonia, dysarthria, voice change after swallowing) (P range, .310−.080). After 6 months, 44 patients showed complete recovery of prestroke swallowing (of whom 35 had recovered within the first month), 3 patients required a modified diet, and 1 enteral nutrition. Conclusions: Compared with historical control studies without rehabilitation treatment, our results showed that early rehabilitation produces dramatic reductions in pneumonia rates and more rapid reuptake of feeding.