Incidence and Prevalence of Dysphagia Following ABI

Authors/Year/

Country/ Study Design/ N

Methods

Outcomes

Halper et al. (1999)
USA
Retrospective Review
N=148

 

Population: TBI; Mean Age=40.21yr; Gender: Male=117, Female=31; Mean Time Post Injury=54d.
Treatment: Chart review of inpatients treated at an acute rehabilitation facility.
Outcome Measure: Functional Independence Measure (FIM), Chewing/Swallowing item on the Rehabilitation Institute of Chicago Functional Assessment Scale (RIC-FAS).

  1. 96 (65%) were diagnosed with dysphagia at admission (RIC-FAS score of <7).
  2. Chewing/swallowing scores at admission were highly correlated with total FIM at admission (r=0.78, p<0.01) and discharge (r=0.79, p<0.01).
  3. A significant correlation was found between chewing/swallowing and cognitive FIM at admission (r=0.67, p<0.01) and discharge (r=0.65, p<0.01).

Mackay et al. (1999b)
USA
Observational
N=54

 

Population: Brain injury; Mean Age=26.8yr; Gender: Male=45, Female=9; Range of GCS Scores=3-8.
Treatment: Consecutive patients treated with early rehabilitation intervention (initiated <24hr of admission) was assessed for swallowing disorders.
Outcome Measure: Videofluoroscopic swallow study (VFSS).

  1. 33 (61%) patients demonstrated one or more swallowing impairments on VFSS examination.
  2. The mean GCS on admission for patients with normal swallowing was significantly higher than that of patients with abnormal swallowing (5.9 vs. 4.6, p<0.01).
  3. 22 (41%) patients aspirated. The mean admitting GCS score of aspirators (4.45) was lower compared to non-aspirators (5.53).

Schurr et al. (1999)
USA
Retrospective Review
N=47

 

Population: TBI; Mean Age=37yr; Gender: Male=32, Female=15; Mean GCS Score=8.
Treatment: Chart review of patients who received a bedside evaluation (speech pathologist). Those with abnormal findings were referred for a swallowing assessment.
Outcome Measure: Videofluoroscopic swallow study (VFSS).

  1. 33 (70%) patients had an abnormal bedside evaluation; 2 were deemed unfit for VFSS the remaining 31 patients received VFSS.
  2. VFSS was abnormal in 22/31 (71%) patients.

Cherney and Halper (1996)
USA
Retrospective Review
N=524

Population: TBI.
Treatment: Review of data collected from a rehabilitation institute.
Outcome Measure: Presence of dysphagia.

  1. 41.6% (218) patients had dysphagia.

Cherney and Halper
(1989)
USA
Retrospective Review
N=189

 

Population: Adults with Head Injury.
Treatment: Review of 18 months of data from a Rehabilitation Institute.
Outcome Measure: Presence of dysphagia.

  1. Approximately 26% of patients (49 of 189) had dysphagia on admission. 
  2. Of the 49 of the patients with dysphagia, more than 60% had a severe problem with oral intake, while only 16% displayed a mild or minimal dysfunction.

Field and Weiss (1989)
USA
Retrospective Review
N=8

 

Population: TBI; Gender: Male=6, Female=2; Mean Age=27.3yr.
Treatment: Review of charts for patients admitted to a head injury rehabilitation program.
Outcome Measure: Videofluorographic examination of a modified barium swallow.

 

 

  1. Of 30 patients admitted to the program, 9 (30%) demonstrated swallowing problems (1 excluded due to incomplete data).
  2. Most common problems were: prolonged oral transit and delayed swallowing reflex, each observed in 87.5% of cases (7/8 patients).
  3. 5/8 (62.5%) of the patients had pooling in the valleculae and in the pyriform sinuses. 
  4. 4/8 (50%) had late triggering of the swallowing mechanism at the pyriform sinus.
  5. 3/8 (37.5%) had the bolus enter the hypopharynx prior to the swallow. 
  6. Aspiration occurred in 37.5% of the cases.
  7. Reduced pharyngeal peristalsis was observed in 2/8 (25%) of the cases. 

Winstein (1983)
USA
Retrospective Review
N=201

 

Population: TBI. Patients With Dysphagia (n=55): Gender: Male=45, Female=10; Male Mean Age=26yr, Female Mean Age-25yr.
Treatment: Chart review of all non-acute patients at an adult trauma service.
Outcome Measure: Swallowing problems.

  1. Swallowing problems were present in 55/201 (27%) patients on admission.
  2. Of 55 patients identified with swallowing difficulties, 45 (82%) were not taking an oral diet and the other 10 (18%) were eating at least a pureed diet.
  3. For swallow (n=41): 3 had normal swallow, voluntarily initiated, coordinated motion, good laryngeal excursion; 21 had good reflex, initiated with external stimulation; and 17 had difficulty (e.g., inadequate laryngeal excursions, uncoordinated swallow, poor endurance, etc.).
  4. Of the 55 patients with issues, 84% were oral feeders at discharge.