Clinical Challenges in the Evaluation and Treatment of Individuals with Poststroke Dysphagia

Although reported frequencies vary due to study design, patient characteristics, and method of ascertainment, dysphagia is a commonly encountered morbidity after stroke. Consequently, speech-language pathologists' clinical caseloads are heavily populated with individuals with poststroke dysphagia. The body of knowledge about swallowing and swallowing disorders has expanded exponentially over the last 3 decades, and speech-language pathologists are increasingly sophisticated in their evaluation and treatment of this patient population. Nevertheless, clinical quandaries persist regarding the management of these individuals. In this article, clinical challenges are discussed, including early detection of dysphagia and aspiration risk, treatment efficacy, refractory dysphagia, and noncompliance with treatment. Research relevant to these issues is reviewed to aid in formulating sound clinical decisions.