Original Research

Clinical outcomes associated with speech, language and swallowing difficulties post-stroke

Stephanie A. Kaylor, Shajila A. Singh
South African Journal of Communication Disorders | Vol 70, No 1 | a957 | DOI: https://doi.org/10.4102/sajcd.v70i1.957 | © 2023 Stephanie A. Kaylor, Shajila A. Singh | This work is licensed under CC Attribution 4.0
Submitted: 21 November 2022 | Published: 10 October 2023

About the author(s)

Stephanie A. Kaylor, Department of Communication Sciences and Disorders, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
Shajila A. Singh, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: There is a lack of prospective research in South Africa’s speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector.

Objectives: This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality).

Method: A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p < 0.01.

Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p < 0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p < 0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p < 0.01, r = 0.70).

Conclusion: In South Africa’s private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.

Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa’s private sector.


Keywords

stroke; acute care; prospective cohort; South Africa; private sector; speech therapy; dysphagia; outcomes

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