الفهرس 
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Abstract
Oropharyngeal dysphagia is a common complication of acute stroke. It is associated with increased morbidity and mortality. Chocking, aspiration, chest infections, malnutrition, prolonged hospital stay, and poor quality of life are common sequels of oropharyngeal dysphagia (Arnold et al., 2016). Therefore, internationally, there is an increased trend for optimal diagnosis and management of the dysphagic patient in the acute hospital setting (Cohen et al., 2016). Indeed, early and accurate identification provides an opportunity for early implementation of suitable lines of treatments with more favorable outcomes (Martino and McCulloch, 2016).This study aimed to assess the value of early diagnosis and management of oropharyngeal dysphagia on the stroke outcomes, to simply screen the oropharyngeal dysphagia and to detect the clinical predictors of dysphagia severity and the clinical predictors of recovery of dysphagia in acute stroke patients. The present study was conducted on 60 patients with acute stroke who were admitted at the Neurology Department - Mansoura University Hospital. The patients were divided into two groups: control and intervention groups with 30 patients for each. Both groups were subjected to follow-up two times a week for two weeks. The first 6 months period of the study was an observation period of the protocol that was routinely used in management of dysphagic patients by neurologists and these patients were taken as a control group. The control group was subjected to history taking, neurological examination (National Institute of Health Stroke Scale NIHSS and cranial nerve examination) and screening using Yale swallow protocol then the usual non-instrumental protocol of oropharyngeal dysphagia management which is trial fluid intake and if any symptom of aspiration appeared as coughing or chocking, Ryle tube feeding was recommended then repeated trial feeding. This routine protocol was conducted by the neurologists in stroke units. The next 6 months, the intervention group was subjected to early interventional instrumental, evidence-based protocol of multidisciplinary management by phoniatricians which is assessment of oropharyngeal dysphagia as a first step as the control group. Then if the patient did not pass the 3-ounce water swallow test, assessment by FEES was done followed by behavioral readjustment swallowing therapy (BRAT). The choice of the therapy technique depended on the physiological breakdown of the swallowing function of the patient. Ryle tube feeding was used if needed until restoral of complete oral intake was achieved if possible. There was a median delay of five (range 3-9) days between admission at hospital and the dysphagia assessment as the GCS must be more than 13 to allow using FEES effectively.