This document summarizes the treatment of a 63-year-old male patient with post-stroke aphasia and dysphagia using the AVANT rehabilitation program. The patient suffered two strokes resulting in quadriplegia and an inability to swallow. He was treated with drug therapy and the AVANT program, which evaluates dysphagia and provides patient education and swallowing exercises. After 21 days in the program, the patient's feeding tube was removed and he could eat semi-liquid and normal foods again. He was discharged on day 25 with continued treatment instructions.

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