Cough Reflex Testing in Acute Stroke: A Survey of Current UK Service Provision and Speech and Language Therapist Perceptions

Autor/inn/en	Trimble, Julie; Patterson, Joanne
Titel	Cough Reflex Testing in Acute Stroke: A Survey of Current UK Service Provision and Speech and Language Therapist Perceptions
Quelle	In: International Journal of Language & Communication Disorders, 55 (2020) 6, S.899-916 (18 Seiten) PDF als Volltext Verfügbarkeit
Zusatzinformation	ORCID (Trimble, Julie)
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	1368-2822
DOI	10.1111/1460-6984.12571
Schlagwörter	Foreign Countries; Neurological Impairments; Speech Language Pathology; Allied Health Personnel; Motor Reactions; Medical Evaluation; Physical Disabilities; Patients; Attitudes; Medical Services; United Kingdom + Suchen Sie Ihr Suchwort? Ausland; Neurodegenerative Erkrankung; Physical handicap; Körperbehinderung; Patient; Attitude; Einstellung; Verhalten; Arzt; Großbritannien
Abstract	Background: Silent aspiration (SA)--airway entry of food, drink or other material without a cough response--is common post-stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. Aims: To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. Methods & Procedures: A cross-sectional web-based survey was developed, piloted and delivered. The survey targeted all UK-based SLTs working in acute stroke settings. Outcomes & Results: A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient-related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set-up and delivery of CRT) and restricted access to instrumental assessments. Conclusions & Implications: This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2024/1/01