Acute Cerebrovascular Accidents (CVA)
Acute cerebrovascular accidents (CVA), or strokes, are common in the United States and are capable of leaving behind many after-effects. CVAs are “the leading neurological cause of pharyngeal dysphagia and intractable aspiration” (Qu, Li, Liang, Su, Chen, & He, 2010, p. 299). In fact, anywhere from 27% to 69% of individuals experience dysphagia after an acute CVA (National Stroke Foundation, p. 97). Those who do not die or experience spontaneous recovery within the first 2 weeks are left with complications like penetration or aspiration, pneumonia, dehydration, weight loss, or negative effects in one’s social life (National Stroke Foundation, p. 97). The role of a speech language pathologist is to provide rehabilitation, and to find the most
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This ensures the patient is kept hydrated without risk of penetration or aspiration. Intravenous hyperalimentation, which consists of nutrition (instead of just fluids) can be administered through an IV as well, but is seldom required. While a nasogastric (NG) tube can provide feedings and medications while reducing the risk of aspiration, it does not eliminate the risk of aspiration completely. The same is true for a percutaneous endoscopic gastrostomy (PEG) tube, which administers nutrients directly through the abdomen and into the stomach. Complications with these tubes may arise, such as premature removal of the tube or “osmotic gradients that lead to diarrhea” (Jauch et al, 2013). The Feed or Ordinary Diet (FOOD) trials studied how CVA patients with the ability to swallow were effected when nutrition was given orally versus nutrition provided through NG or PEG tubes. These trials also looked at how implementation of an NG tube within 7 days post CVA changed the outcome for this population, as well as outcome differences between PEG and NG tubes 2 to 3 weeks post-onset. Results indicated that NG tubes “substantially decreased the risk of death, and that early feeding via an NG tube resulted in better functional outcomes than feeding by PEG” (Jauch, et al, 3013). An issue noted with both of these treatments is that they are not permitted in most facilities that provide long-term care, therefore limited the care these patients can receive. While the National Stroke Foundation (located in Melbourne Australia) supports the conclusions made after the FOOD trails, the American Stroke Association has claimed that not enough evidence has been retrieved from these studies to make any definitive statements (Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., . . . Zorowitz, R. D., 2016, page
This ensures the patient is kept hydrated without risk of penetration or aspiration. Intravenous hyperalimentation, which consists of nutrition (instead of just fluids) can be administered through an IV as well, but is seldom required. While a nasogastric (NG) tube can provide feedings and medications while reducing the risk of aspiration, it does not eliminate the risk of aspiration completely. The same is true for a percutaneous endoscopic gastrostomy (PEG) tube, which administers nutrients directly through the abdomen and into the stomach. Complications with these tubes may arise, such as premature removal of the tube or “osmotic gradients that lead to diarrhea” (Jauch et al, 2013). The Feed or Ordinary Diet (FOOD) trials studied how CVA patients with the ability to swallow were effected when nutrition was given orally versus nutrition provided through NG or PEG tubes. These trials also looked at how implementation of an NG tube within 7 days post CVA changed the outcome for this population, as well as outcome differences between PEG and NG tubes 2 to 3 weeks post-onset. Results indicated that NG tubes “substantially decreased the risk of death, and that early feeding via an NG tube resulted in better functional outcomes than feeding by PEG” (Jauch, et al, 3013). An issue noted with both of these treatments is that they are not permitted in most facilities that provide long-term care, therefore limited the care these patients can receive. While the National Stroke Foundation (located in Melbourne Australia) supports the conclusions made after the FOOD trails, the American Stroke Association has claimed that not enough evidence has been retrieved from these studies to make any definitive statements (Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., . . . Zorowitz, R. D., 2016, page