Evidence-based intervention options for chronic dysphagia following lateral medullary stroke

Clinical Question: Are rehabilitation techniques more effective than compensatory strategies in improving swallow function and facilitating oral intake after a medullary stroke? Method: A review of research comparing treatment outcomes between compensatory strategies and rehabilitative techniques for individuals with chronic dysphagia secondary to brainstem stroke was completed. Study Sources: Cochrane Database of Systematic Reviews, Evidence-Based Medicine Reviews, PubMed®, MEDLINE®, CINAHL®, Social Sciences Citation Index® (Web of Science®), EMBASE, and speechBITE™ Search Terms: (Dysphagia OR Deglutition Disorders) AND (Lateral Medullary Stroke; OR Lateral Medullary Syndrome; OR Wallenberg Syndrome; OR brainstem stroke) AND (Therapy outcomes; OR treatment efficacy; OR rehabilitation; OR intervention; OR compensatory OR compensation) Primary Results: Results from a review of the literature yielded only seven articles with enough detail in their descriptions to enable clinical replication. Of these, only one represented an experimental group design of a high standard of evidence; the others comprised case series and case study designs. Results indicate positive outcomes for the use of both compensatory strategies and rehabilitation techniques. Most individuals make improvements in swallow physiology and functional oral intake status. Conclusions: The majority of studies reviewed in this brief represent lower levels of evidence. However, results do reflect positive clinical outcomes with benefits of both compensation and rehabilitation reported. Regular application of compensatory techniques may produce improvements to swallow physiology over time. The majority of patients appeared able to return to some form of oral intake following therapy.