The assessment of dysphagia after stroke: state of the art and future directions.

Dysphagia is a major complication following an acute stroke that affects the majority of patients. Clinically, dysphagia after stroke is associated with increased risk of aspiration pneumonia, malnutrition, mortality, and other adverse functional outcomes. Pathophysiologically, dysphagia after stroke is caused by disruption of an extensive cortical and subcortical swallowing network. The screening of patients for dysphagia after stroke should be provided as soon as possible, starting with simple water-swallowing tests at the bedside or more elaborate multi-consistency protocols. Subsequently, a more detailed examination, ideally with instrumental diagnostics such as flexible endoscopic evaluation of swallowing or video fluoroscopy is indicated in some patients. Emerging diagnostic procedures, technical innovations in assessment tools, and digitalisation will improve diagnostic accuracy in the future. Advances in the diagnosis of dysphagia after stroke will enable management based on individual patterns of dysfunction and predisposing risk factors for complications. Progess in dysphagia rehabilitation are essential to reduce mortality and improve patients' quality of life after a stroke.

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Declaration of interests BL received a research grant from the medical faculty of the University of Muenster for a clinician scientist rotational position. SH received a research grant from the UK Medical Research Council on cerebellar stimulation in dysphagic stroke paid to the University of Manchester, and a research grant from the UK Health Technology Assessment/National Institute for Health and Care Research (HTA/NIHR) on pharyngeal stimulation in dysphagic stroke paid to the University of Manchester; received consulting fees from Phagenesis for acting as chief scientific officer; received honoraria from the Chinese Dysphagia Research Forum 2021 for a lecture and presentation on neuromodulation in dysphagic stroke; received support for attending the European Society for Swallowing Disorders conference 2022; acts as chair for the trial steering committee of a device for personal protextive equipment, and as chair of the medical technologies advisory committee (April, 2021–present); is a board member and director of Phagenesis (2010–present); and holds foundation shares of Phagenesis and Anisys. MTG received payment for expert testimony from Phagenesis for involvement in a study as a reviewer of FEES videos. SSK was supported by an endowed professorship from the Else Kröner Fresenius Stiftung. PMB received support from Phagenesis (provision of devices for the NIHR HTA-funded PhEAST trial) and has received consulting fees from Phagenesis as a member of the advisory board. RD received consulting fees from Daiichi Sankyo and Pfizer; received honoraria for lectures from Daiichi Sankyo, Pfizer, and Alexion; received honoraria from Phagenesis paid to the University Hospital Münster for participating in the steering committees of different trials; and has received reimbursement of travel expenses as a board member of the European Society for Swallowing Disorders and as a board member of the German Dysphagia Society. All other authors declare no competing interests.