الفهرس 
Purpose of the studyOnly 14 pages are availabe for public view
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Abstract
Dysphagia is a condition where a person has difficulty swallowing both foods that are liquid or solid that is a frequent complication in stroke patients, which occurs in 50% of patients with stroke because stroke patients have difficulty controlling the tongue and cannot chew and swallow food particles because the swallowing phase in the oral and pharynx is disrupted so cause medical complications including increased hospitalization, morbidity, and risk of aspiration pneumonia and it is associated with poor psychosocial health outcomes such as reduced nutrition, hydration and quality of life which patients with dysphagia have longer lengths of hospital stay and higher healthcare costs. (Verity et al., 2023).Current management of dysphagia involves compensation and rehabilitation, compensatory techniques such as modifying diet and fluid consistencies that enable safe swallowing but do not alter long-term function and rehabilitative exercises, however, can improve swallowing function and resumption of oral intake or normal food and drink, rehabilitative exercises can be indirect (motor without swallow) or direct (motor with swallow), indirect exercises aim to strengthen muscles involved in swallowing such as the Shaker head-lift and tongue strengthening exercises where direct exercises involve the action of swallowing such the Mendelsohn maneuvre and effortful swallow studies have shown that the positive effects of rehabilitative exercises on reducing the severity and symptoms of post-stroke dysphagia (Choy et al., 2022).The purpose of this study: to determine the effect of dysphagia exercises on post stroke outcomes.Settings: The study was conducted at the neurological department at Menoufia University Hospital, Menoufia governorate, Shebin Elkom, Egypt. Psychological and neurological department located in eighth floor in Menoufia university hospital. It consists one room for male and another room for female each room contains nine beds in addition to another room contains five beds for male and female and intermediate care contains six beds.Subjects: Consecutive sample of 50 adult male and female patients post stroke were divided equally into two groups (study & control) 25 patients for each group.Instruments of the study: Three instruments were used by the researcher. These instruments are:1- InstrumentI: Structured interview questionnaire: It included three parts:• Part one: Social characteristic • Part two: Medical data • Part three: Patients’ Knowledge assessment2- Instrument II: Gugging Swallowing Screen Scale (GUSS):It included two parts:• Part one: Indirect swallowing test• Part two: direct swallowing test3- Instrument III: Functional Independence assessment The main findings of the present study were:• There was highly significantly improvement in total knowledge score among study.group (I) than control group (II) post and follow up intervention.• There was highly significant reduction in dysphagia score among Study group (I) than control group (II) post and follow up.• There was highly significantly improvement in function independent level study.group (I) than control group (II) post and follow up intervention.Conclusions: Based on the findings of the current study, it can be concluded that:Dysphagia exercises had high significant effect on improvement of the level of dysphagia among study group (group I) than the control group (group II)Nearly two third of the study group had moderate dysphagia compared to the entire control group that had sever dysphagia in post intervention.Dysphagia exercises had high significant effect on improvement of the level of knowledge among study group (group I) than the control group (group II) .All study group attained good knowledge level compared to all control group that had poor in knowledge post intervention.
Dysphagia exercises had high significant effect on improvement of the level of functional independence among study group (group I) than the control group (group II). Nearly half of the study group had partially dependent level compared to all of control group that had completely dependent in post intervention.Recommendation: Based on the findings of the present study, the following recommendations are derived and suggested:A-Recommendations for patients:• All patients admitted with a diagnosis of stroke (confirmed or not), in the acute phase, to implement a dysphagia screening protocol. It is recommended that screening be performed as early as possible, before any liquid, food or medication ingestion.• The framing, implementation and utilization of clinical guidelines, grounded on the best available evidence and adjusted to clinical contexts, guarantee the quality and excellence of care provided to stroke patients.• Dysphagia screening protocols use validated screening instruments. The Gugging Swallowing Screen (GUSS), due to its psychometric properties, seems to be an adequate instrument.• Consider behavioral intervention, including compensatory strategies (modification of food consistencies and liquid viscosity, postural and swallowing techniques) and rehabilitation (muscle-strengthening exercises, resistance or skills training), as a treatment component of dysphagia in stroke patients.Using direct and indirect methods to achieve treatment; direct method is associated with the use of foods and achieves treatment through diet adjustments, and diverse posture changes, while indirect method is associated with the stimulation or behavioral swallowing techniques without the direct use of food.• Comprehensive exercise programs, rather than maintaining one exercise, in combination with the stimulation treatment for the actual treatment for patients with swallowing disorders, as well as with the needs of an intensive program, which can be conducted in a ward, considering insufficient time spent in occupational therapy and reduced compliance of patients and caregivers.• A simplified, comprehensive and illustrated Arabic guided images booklet about dysphagia management should be distributed for each newly admitted patient and their family diagnosed with stroke.B- Recommendation for further research:• A similar study can be replicated at different settings and on a larger probability sample to allow for greater generalization of the findings.• Apply educational programs about dysphagia management for nurses about the continuous health promotion for patients with stroke in hospitals.The importance of the multidisciplinary team and regular reevaluation will be emphasized as well.