SmartStrokes 2013 wileyblackwellhealth

An early but landmark study by Splaingard, et al. (1988) documented that clinical swallowing assessment identified only 42% of patients who were consequently found to aspirate on videofluoroscopic swallowing study. More concerning is that of those patients with severe aspiration documented on the radiographic swallowing assessment, 70% were not identified as aspirating at bedside. The findings of this early study have been replicated through numerous subsequent reports. The critical flaw in the clinical swallowing assessment lies in the nature of impairment in many neurologically impaired patients. For patients with neuro-sensory impairment, cough response to aspiration may be absent or impaired. This leaves the clinician with a diagnostic conundrum: Is the patient aspirating but without cough response? Or is the patient not aspirating?
Cough reflex testing consists of challenging the sensory integrity of the aerodigestive tract by introduction of a tussive agent. This particular test has been studied in respiratory medicine over a span of 50+ years. Only recently has a derivative been applied to clinical swallowing assessment as a means to evaluate the integrity of sensory responses in the pharynx. This presentation will present an overview of research, from our lab and others, related to the application of the cough reflex test in clinical dysphagia assessment. Strengths and limitations of this test will be highlighted as well as direction for future research which will better establishment the sensitivity and specificity of this test.

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Maggie Lee as an IJS/SMARTSTROKES collaboration.

Sexual concerns and difficulties after stroke are common among stroke survivors and their partners. The emotional impact of stroke can be huge, while the physical and psychological effects can create new difficulties in meeting sexual and intimacy needs. When to resume sex life after stroke can be as important as other aspects of recovery, such as mobility, communication and daily living skills. Nevertheless, many health care professionals are not always open or comfortable discussing, or may feel reluctant or ill prepared to address client’s sexual concerns. This presentation aims to provide, from a sex therapy perspective, an in-depth understanding of “What’s sex about”. I shall discuss 10 healthy benefits of sexual expression and 6 healthy strategies for stroke survivors to achieve sexual satisfaction. I shall also present some ideas on sexual enjoyment and intimacy fulfillment after stroke. I hope with the information, the conference participants may share with their clients in practice. After all, sex life is more than sexual intercourse. It is a human right for everyone, regardless of disability or illness, to have a fulfilling and satisfying sexual life.

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Matthew for this IJS/SMARTSTROKES collaboration.

Emotional problems occur regularly after stroke and are distressing, but also impact on functional outcome. The UK experience is that there are not insufficient resources for psychologist to review every patient, nor is it felt this is necessary. On this account a stepped approach to psychological care has been developed, encompassing prevention and intervention, stepped according to need. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Ian Kneebone as an IJS/SmartStrokes collaboration.