Evidence-Based Statements recommendation  levels 

Grades / Levels of Evidence

Eating assessment tool (EAT-10) can be used as a dysphagia screening tool (1)

Strong Recommendation;

Moderate Evidence 

All patients should receive a formal dysphagia screen by either water swallow test or multiple consistency test as fast as possible following admission secondary to acute stroke. Until such time that this screening can be conducted and swallowing has been judged to be safe, no administration of any food or liquid, including oral medication, is recommended (1)

Strong Recommendation,

Moderate Evidence 

All stroke patients failing a dysphagia screen and/or showing other clinical predictors of post-stroke dysphagia (i.e., severe aphasia, severe dysarthria, severe facial palsy, and/or severe neurological deficit) should receive a dysphagia evaluation as soon as possible. In addition to clinical swallow examination, videofluoroscopic swallow study, or, preferably, fiberoptic endoscopic evaluation of swallowing should be available. Evaluation should routinely include swallowing of tablets, liquids, and different food consistencies and quantities (1)

Weak Recommendation,

Low Evidence

For individuals with dysphagia secondary to stroke, texture modification and/or thickened liquids may be utilized to reduce risk of pneumonia (1)

Weak For Recommendation

Low Evidence

These modified textures and viscosities must only be prescribed based upon an appropriate assessment of swallowing. (1)

Strong for Recommendation

Low Evidence

Additionally, these patients should be monitored for fluid balance and nutritional intake (1)

Strong Recommendation

Moderate Evidence 

Behavioral swallowing exercises (defined as including exercises, maneuvers, postural changes, and expiratory muscle strength training within this guideline) to rehabilitate swallow function are recommended for individuals with dysphagia status post stroke, however the training program should be tailored to the specific swallowing impairment of the individual based upon assessment findings (1)

 Weak Recommendation

Moderate Evidence

Oral care interventions are recommended in patients with dysphagia secondary to stroke in order to reduced pneumonia risk (1)

Weak Recommendation

Low Evidence

Swallowing fluoroscopy may also be appropriate in evaluating patients with globus pharyngeus, chronic cough, regurgitation, or recurrent pneumonia (2)

recommendation

Moderate Quality of Evidence

Videofluoroscopic swallow studies (VFSS) are appropriate for patients with suspected swallowing impairments from the oral to the pharyngoesophageal phases of deglutition or patients with inconclusive or incongruent clinical swallow exam results (2)

recommendation

Low Quality of Evidence

VFSS should be the assessment tool used for patients with known neurologic diseases or with liquid dysphagia complaints (2)

recommendation

High Quality of Evidence

When conducting a videofluoroscopic swallow study (VFSS), clinicians should follow "a standardized and reproducible stepwise protocol including the lateral and anterior-posterior (AP) views" (2)

recommendation

Moderate Quality of Evidence

As clinically appropriate, VFSS protocol should progress from the smallest bolus volume to larger volumes and multiple consistencies and solids should be used (2)

recommendation

Moderate Quality of Evidence

In patients with post-stroke dysphagia and insufficient oral intake we suggest an early enteral nutrition via a nasogastric tube.(1)

Weak recommendation

Quality of evidence: Moderate

In patients with post-stroke

dysphagia, we suggest treatment with rTMS, TES, tDCS and PES as adjunct to conventional dysphagia treatments to improve swallowing function.(1)

Weak recommendation

Moderat