Dysphagia following strokes: clinical observations of swallowing rehabilitation employing palatal training appliances.

A retrospective study was undertaken to evaluate the progress of a group of dysphagic stroke patients for whom a dental prosthesis the Palatal Training Appliance (PTA), was used in the active rehabilitation of the swallowing mechanism. Patients selected were those who had sustained a stroke uncomplicated by other neurological illness, during one 12-month period, and whose dysphagia caused anxiety to the medical staff in the hospital ward. Thirty severely dysphagic stroke patients satisfied these criteria. The study recorded the duration and type of supplementary feeding required during hospitalization. Thirteen patients had evidence of aspiration before the PTA was fitted and 5 afterwards. Seven patients died, but only 1 was recorded as having a febrile illness which may have contributed to the death. At discharge, which averaged 10 weeks after admission, 22 of the 23 survivors were taking an adequate oral diet. It was also noted that almost half of the patients who wore dentures before the cerebrovascular event were unable to control them afterwards, adding to their neurological swallowing difficulties. The fitting of a PTA and correction of unstable dentures appeared to help both motivation and function. The results show an improvement in the rehabilitation of oral feeding compared with previous reports by other authors, who did not use the dental appliance. There did not appear to be any medical contraindication to its use.