EBP Compendium: Summary of Clinical Practice Guideline
American Medical Directors Association (AMDA)
Stroke Management and Prevention in the Long-Term Care Setting
American Medical Directors Association.
Columbia (MD): American Medical Directors Association, 42 pages.
AGREE Rating: Recommended with Provisos
This guideline provides recommendations for the management and prevention of stroke in the long-term care setting. The target audiences for this guideline include members of the interdisciplinary medical team.
- Assessment Areas
- Cognition - "It is important to assess cognitive status in stroke survivors because stroke can cause or exacerbate cognitive decline and dementia... The method of cognitive assessment will depend on the abilities of the patient and the experience of the multidisciplinary team. Useful tools include the Mini-Mental State Examination or the Informant Questionnaire on Cognitive Decline in the Elderly” (p. 14).
- A trained practitioner, nurse, or speech therapist should screen for dysphagia in acute stroke patients. Screening should include an assessment of level of consciousness, ability to follow commands, gross strength and coordination of facial, mouth, and tongue muscles, and ability to swallow 3 ounces of water without signs/symptoms of impairment (pp. 15-16).
- “Any abnormalities detected in the screening clinical examination may prompt consideration of a formal dysphagia assessment by a speech therapist…” which may include
- pre- and post-stroke swallowing status comparison
- oral feeding prognosis
- oral motor structure and function (including palate and voice) at rest and with volitional movement
- oral stage of swallowing, including management of secretions and food and drink of different bolus sizes and consistencies
- pharyngeal stage of swallowing, including volitional dry swallow and swallowing of various consistencies and sizes of food and drink
- effect of therapeutic and postural techniques on swallowing function (p. 16).
- Speech and Language - A full communication assessment should include
- auditory/visual comprehension (including auditory/visual attention and memory)
- oral motor structure and function (including palate and voice)
- verbal/written expression (including thought organization and reasoning) (p. 14).
- Assessment Instruments
- FEES/Videofluoroscopy - Factors identified in the initial swallowing evaluation may prompt a recommendation for instrumental assessment such as modified barium swallow, fiberoptic endoscopic evaluation of swallowing, or flexible endoscopic evaluation of swallowing with sensory testing (p. 16).
- Compensatory Treatment & Diet Modification - “Treatments that are based on the identification of swallowing abnormalities could plausibly reduce the frequency or severity of aspiration and thus decrease aspiration pneumonia. Most such treatments, however, have not been proven effective in clinical trials. For example, common compensatory strategies, such as chin-tuck, positioning, dietary modifications, and thickened liquids, may improve some symptoms or findings on videofluoroscopy, but these intermediate outcomes do not necessarily translate into reductions in the incidence of aspiration pneumonia. In addition, modified diets and thickened liquids have potential adverse effects, which include weight loss, dehydration, and reduced quality of life” (pp. 23-24).
Access the Guideline
Added to Compendium: November 2011