![• PSD has been reported in 50.9%
of IS patients. [Arnold, M., et al. 2016.
PloS one]
• PSD is associated with
malnutrition, aspiration, and
pneumonia [Arnold, M., et al. 2016.
PloS one]
Post-stroke dysphagia
• An independent variable predicting death and
disability at 90 days [Smith, E. E., et al. 2018. Stroke]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Post stroke aphasia - avant program - mondsee 2019
- 1. TREATMENT OF POST-STROKE APHASIA - AVANT PROGRAM Dang Phuc Duc, MD. Ph.D - Military Hospital 103, Vietnam 26th INTERNATIONAL MONDSEE MEDICAL MEETING Salzburg, Austria / September 12 - 13, 2019
- 2. • PSD has been reported in 50.9% of IS patients. [Arnold, M., et al. 2016. PloS one] • PSD is associated with malnutrition, aspiration, and pneumonia [Arnold, M., et al. 2016. PloS one] Post-stroke dysphagia • An independent variable predicting death and disability at 90 days [Smith, E. E., et al. 2018. Stroke]
- 3. Comparison of outcome in dysphagic and non-dysphagic patients [Arnold, M., et al. 2016. PloS one]
- 4. AVANT PROGRAM (Austrian Vietnamese Advancement Neurorehabilitation Treatment)
- 5. Dysphagia intervention according to the AVANT
- 6. PATIENT INFORMATION • Nguyen Van T, male , 63 years old • medical history: Dyslipidemia Hypertension Ischemic stroke in 9/2018 (completely recovered).
- 7. Onset symptoms: (February 16th, 2019) • Left hemiplegia • Aphasia • Dysphagia
- 8. After 2 weeks… New stroke attack Right hemiplegia Increased aphasia Absolutely unable to swallow Nasogastric tube 1st attack 2nd attack
- 10. The patient was transferred to the Stroke department – Military 103 hospital • GCS 15 • Dysphagia: GUSS 0/20 • Aphasia: patient's speech is so slurred. • Quadriplegia: MRC left 2/5; right 3/5
- 11. Challenges MRI: infarction injuries on both sides of pontine
- 12. Dysphagia in patients with pontine infarction • Pontine infarction constitutes approximately 7% of all ischemic infarctions. • Dysphagia in patients with bilateral pontine infarction 2.2 times higher than unilateral pontine infarction. [Chang, M. C., et al. (2018). Neural regeneration research]
- 13. Treatment Previous prescription: 1. Clopidogrel 75mg 2. Natrilix 1.5mg 3. Lipitor 10mg New prescription: Clopidogrel 75mg Natrilix 1.5mg Lipitor 10mg Cerebrolysin 20ml per day Rehabilitation: AVANT
- 14. Avant • A rehabilitation team • Evaluation of the patient’s dysphagia • Instructions for patient Explanation on the mechanism Causes of dysphagia Positions for eating and drinking Suitable food and drink Exercises for muscles involved swallowing (lips, tongue, cheeks, etc.) • Design an exercise program
- 15. Day 7 • The feeding tube was removed. • The patient could eat semi-liquid food (soup) and drink sip of 5ml water from spoon.
- 16. Day 21 • Patient could eat normal food such as rice, noodles, vegetables, etc
- 17. Day 25 • The patient is discharged and given instructions on the administration of drugs and exercises at home.
- 19. Thank you
Editor's Notes
- Patients with dysphagia had a higher probability of pneumonia, mortality rate; and a lower chance to get favorable outcome as compared to non-dysphagic patients
- - AVANT is an assistance program of Austria for Vietnam to improve the quality of rehabilitation for stroke patients. - Many Vietnamese doctors and nurses have participated in AVANT training program. - So far, the results obtained show that this is a very effective program.
- * The swallowing rehabilitation program for patients is divided into 2 parts: direct and indirect intervention. - Direct intervention includes measures such as: - Indirect intervention includes measures such as:
- The patient was hospitalized and treated at Thai Nguyen Hospital, a hospital in the northern mountainous region of Vietnam
- On the 14th day after onset. Patients suddenly appear hemiplegia right side more. He was unable to pronounce. The patient cannot swallow.
- - patients need enteral feeding through a nasogastric tube
- - Thai Nguyen Hospital prognosis that the patient was severe and complex. So they transfered him to Military 103 hospital. - The disease status at admission is as follows:
- Brain MRI shows bilateral pontine infarction - With such injury characteristics, patients are at risk of severe disability, especially swallowing function.
- - After evaluation, we decided to keep the previous prescription and add cerebrolysin. - In addition, we apply the rehabilitation method under the AVANT program.
- Before conducting rehabilitation exercises, we consulted the patient about swallowing disorders, including: mechanisms, causes, eating postures, appropriate foods, exercises. swallow... After that, we set up the exercise program and informed the patient.
- On day 7, patients had hiccups due to nasogastric tube irritated the stomach. We removed tube. …
- On day 21, …
- And, this is the patient's current images. He was able to perform most of his daily activities, eat and drink.