About The Book

Dysphagia Following Stroke, Third Edition is a practical and easy-to-use resource for clinicians treating swallowing disorders in the stroke population. The authors bridge the gap between academic and clinical practice with up-to-date research and clinical case examples throughout.

In addition to a thorough overview of dysphagia diagnosis and management, this text focuses heavily on evaluation and management of stroke. Key topics include neural underpinnings of normal and disordered swallowing, swallowing screening, the clinical swallowing examination including cough reflex testing, the expanding array of instrumental swallowing modalities, and the rehabilitation of swallowing including strength training, non-invasive brain stimulation, and skill training. While geared toward practicing clinicians, Dysphagia Following Stroke is also useful for students in professional training programs.

New to the Third Edition

  • A third author, Kristin Gozdzikowska, bring a fresh perspective as a young clinician and researcher with particular expertise in high resolution manometry and various cutting-edge treatment techniques
  • New larger 6″ x 9″ trim size
  • Updated chapters on assessment to include new and emerging instrumental technologies, including high resolution manometry, impedance, and ultrasound
  • Updated chapters on management to include the newly described International Dysphagia Diet Standardization Initiative
  • New and expanded framework for rehabilitation, with a shift from peripherally focused rehabilitation to neuromodulation of cortical swallowing control
  • New and updated research and trends in clinical practice throughout
  • Access to a PluralPlus companion site with videos and clinical forms

About The Authors

Stephanie K. Daniels, PhD, CCC-SLP is a Professor in the Department of Communication Sciences and Disorders at the University of Houston. She worked as a hospital-based speech pathologist for approximately 20 years prior to focusing on a research career. Her research, funded by the Department of Veterans Affairs, is focused on neurogenic dysphagia, primarily in stroke. She has pursued an understanding of the neural underpinnings of swallowing as well as evidence-based evaluation of neurogenic dysphagia. She is an ASHA Fellow and past President of the Dysphagia Research Society

Maggie-Lee Huckabee, PhD practiced as a clinical speech language pathologist for 15 years before the frustration of never knowing ‘the answers’ led her to an academic career. She is now Founder and Director of the University of Canterbury Rose Centre for Stroke Recovery and Research and Professor in the Department of Communication Disorders in Christchurch, New Zealand. She still hasn’t found ‘The Answers’ but is trying, with research interests focusing on the complexities of behaviorally-driven neural adaptation and biomechanical change leading to swallowing recovery following neurological injury.

Kristin Gozdzikowska, PhD, CCC-SLP received her Master’s Degree from the University of Washington, and worked clinically as a Speech Language Pathologist in acute care and inpatient rehabilitation. Through this work, she developed a specific interest in the assessment and management of swallowing impairments after neurologic impairment. This was expanded in her doctoral research, completed in 2016 under the supervision of Prof Maggie-Lee Huckabee. Kristin completed a Post-Doctoral Fellowship investigating clinical application of High-Resolution Manometry at the University of Canterbury Rose Centre for Stroke Recovery and Research, and is now working in a dual clinical-research role at the Laura Fergusson Trust. Kristin has been as invited to speak at international conferences including the Dysphagia Research Society and the American Speech-Language Hearing Association Convention.

Table Of Contents

Foreword by Karen French Montoya
Online Resources

Chapter 1. Introduction to Dysphagia and Stroke
Overview of Stroke
Dysphagia in Stroke
Multidisciplinary Management of Dysphagia in Stroke

Chapter 2. The Neural Control of Swallowing: From Central to Peripheral
Methods for Understanding Neural Control
Higher Nervous System Control
Brainstem Mechanisms
Peripheral Neuromuscular Mechanisms

Chapter 3. Normal Swallowing Anatomy and Physiology
Defining Normal and Abnormal Swallowing
Phases of Swallowing

Chapter 4. Swallowing Screening in Patients with Acute Stroke
Background of Screening Swallowing in Stroke
Components of a Good Screening Tool
Models for Screening Implementation
Implementation of a Nursing-Administered Swallowing Screening Tool
Available Swallowing Screening Tools

Chapter 5. The Clinical Swallowing Examination: History, Patient Interview, Informal Cognitive and Communication Assessment
Introduction to the Clinical Swallowing Examination
Patient History
Patient and Family Interview
Informal Assessment of Cognition and Communication

Chapter 6. The Clinical Swallowing Examination: The Evaluation of the Oral Mechanism
Structural Integrity
The Cranial Nerve Examination: Inferring Physiology
Extending the Cranial Nerve Examination: The Cough Reflex Test
Case Example

Chapter 7. The Clinical Swallowing Examination: Assessment of Oral Intake
Executing the Assessment of Oral Intake
Interpreting the Assessment of Oral Intake

Chapter 8. The Clinical Swallowing Examination: Predicting Dysphagia and Aspiration
The Clinical Swallowing Examination with a Focus on Clinical Features Predicting
Dysphagia and Aspiration
The Mann Assessment of Swallowing Ability

Chapter 9. Adjuncts to the Clinical Swallowing Examination
The Timed Water Swallowing Test
The Test of Masticating and Swallowing Solids
Assessment of lingual palatal pressure
Pulse Oximetry
Cervical Auscultation

Chapter 10. The Instrumental Swallowing Examination: The Videofluoroscopic Swallowing Study
The Need for Diagnostic Specificity
The Videofluoroscopic Swallowing Study

Chapter 11. The Instrumental Swallowing Examination: Evaluation of Swallowing Respiratory Coordination-An Auxiliary to the Videofluoroscopic Swallow Study
Executing the Evaluation of Swallowing Respiratory Coordination
Interpreting the Evaluation of Swallowing Respiratory Coordination

Chapter 12. The Instrumental Swallowing Examination: Videoendoscopic Evaluation of Swallowing
Executing the Videoendoscopic Evaluation of Swallowing
Interpreting the Videoendoscopic Evaluation of Swallowing

Chapter 13. The Instrumental Swallowing Examination: Manometric Evaluation of Swallowing
Low Resolution Manometry
High Resolution Manometry
What Can Manometry Offer to Clinical Practice?

Chapter 14. The Instrumental Swallowing Examination: Ultrasound Evaluation of Swallowing
The Need for Diagnostic Specificity
Ultrasound Imaging: The Method
Muscle Morphometry
Swallowing Kinematics
Emerging Applications

Chapter 15. Professional Responsibilities: Dysphagia Diagnosis in Stroke
Case Example

Chapter 16. Diagnosis of Dysphagia in Stroke
Oral Phase
Pharyngeal Phase
Oral and Pharyngeal Dysmotility in Stroke

Chapter 17. Diet Considerations: To Feed or Not to Feed
An Overview of Options for Feeding the Patient with Dysphagia
Non-oral, Enteral Feeding Options
Decision Making for Non-oral Nutrition
Free Water
Oral Hygiene

Chapter 18. Compensatory Management of Oropharyngeal Dysphagia
Postural Changes
Sensory Enhancement
Volitional Control of Oral Transfer
Breath-holding Techniques
Bolus Modification

Chapter 19. Principles of Rehabilitation for Oropharyngeal Dysphagia
Diagnostic Precision for Rehabilitative Effectiveness
Principles of Neural Plasticity
The Take-Home Point

Chapter 20. Rehabilitation of the Peripheral Sensorimotor Swallowing System
Peripheral Muscle Strengthening
Peripheral Sensory Stimulation

Chapter 21. Central Rehabilitation for Oropharyngeal Dysphagia: Extrinsic Modulation
Central Stimulation Techniques
Translating rTMS and tDCS into Clinical Dysphagia Rehabilitation
The Need for Intelligent Enthusiasm

Chapter 22. Central Rehabilitation for Oropharyngeal Dysphagia: Behavioral Adaptation
Skill based training paradigms: Dysphagia as a motor planning disorder
Biofeedback Modalities
Take-Home Points

Chapter 23. Medical and Surgical Management
Medical Management
Surgical Intervention

Chapter 24. Lagniappe
Management Effectiveness with Stroke Patients
Last Thoughts



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