Key Points

  • The incidence of dysphagia in patients post ABI ranges from 26% to 70%. More specifically, the range was between 26% and 42% for individuals entering a rehabilitation facility.
     
  • The incidence of dysphagia has been shown to vary depending on the definition of dysphagia used and the acuity of the patient at admission.
     
  • Post ABI aspiration improves in many patients over the first year, with many improving within the first three months post injury.
     
  • The incidence of silent aspiration among individuals with ABI has not been well documented.
     
  • Silent aspiration may be missed in the absence of a modified barium swallow study.
     
  • The risk of developing pneumonia appears to be proportional to the severity of the aspiration.
     
  • Videofluoroscopic Modified Barium Swallow (or Modified Barium Swallow) studies may be used as a tool to assist in dysphagia management and identification of aspiration in the ABI population.
     
  • Although FEES may be less invasive and less costly to complete, further investigation would be beneficial to determine its effectiveness in identifying swallowing difficulties or aspiration post stroke. To determine its effectiveness within the ABI/TBI population, more research needs to be done.
     
  • There is limited evidence supporting the use of pulse oximetry alone to detect aspiration in patients who have had a stroke.
     
  • Pulse oximetry does not appear to be as sensitive a test as VMBS in determining aspiration post stroke.  Research needs to be completed within an ABI population.
     
  • Modified Evans Blue Dye Test may be beneficial if patients aspirate more than trace amounts.
     
  • Caution is recommended when using the MEBD test alone to ascertain aspiration in individuals who have a tracheostomy.
     
  • There is consensus opinion that patients should be screened for swallowing deficits in a timely manner using a valid screening tool.
     
  • There is consensus opinion that a referral to a speech-language pathologist, occupational therapist, dietitian or other trained dysphagia clinician for a detailed assessment and identify the appropriate course of treatment.
     
  • Based on the stroke literature, individuals with dysphagia should feed themselves whenever possible.  When not possible, low-risk feeding strategies should be used.
     
  • Education in oral health and good oral care is needed to reduce the risk of dysphagia and other swallowing complications that can result from a brain injury.
     
  • Good oral health can promote recovery and reintegration into society by reducing some of the negative consequences associated with poor oral hygiene.
     
  • Maintaining good oral health during hospitalization may help to reduce the risk of nosocomial infections by decreasing dental bacterial colonization and hospital recovery time.
     
  • Good oral care has not been shown to have any adverse effects on normal intracranial pressure or cerebral perfusion pressure values in intubated patients.
     
  • Although there are several possible interventions to treat dysphagia, there is no clinical evidence to support their efficacy specifically within an ABI population. More research is needed.
     
  • Following an ABI, malnutrition may be present in patients with severe injuries within the first months post injury. 
     
  • The incidence of obesity in the chronic stages of injury was comparable to the normal population.
     
  • Both enteral and parenteral feeding are safe and have been shown to provide an increase in caloric intake; however, there is conflicting data as to which method allows for the greatest increase in nitrogen balance.
     
  •  Enteral feeds are less expensive and maybe more effective than parenteral feeds.
     
  • Further research is needed to investigate the effect of both feeding routes on nitrogen balance and mortality.
     
  • Early parenteral nutrition support of ABI patients appears to modify immunologic function.
     
  • There is an increased risk of developing pneumonia for ventilated patients fed by a naso-gastric versus a gastrostomy tube.
     
  • The therapeutic benefits of using metoclopramide to aid in gastric emptying are minimal.
     
  • Zinc supplementation in the immediate post injury period has shown to be beneficial in terms of neurological recovery and visceral protein concentrations in ABI patients.
     
  • Growth hormone enhances nutritional repletion, but it unclear as to whether or not it improves nitrogen balance.
     
  • High nitrogen feedings are necessary to restore massive nitrogen loses post-ABI.
     
  • Supplementation of BCAAs in patients with ABI enhances recovery of cognitive function.