{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:22:47Z","timestamp":1753878167004,"version":"3.41.2"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dysphagia is a common complication of stroke, and enteral feeding is often necessary. If present, cognitive impairment can complicate the process of reintroducing oral intake. There is limited evidence concerning the outcomes of enteral feeding with this particular patient group and decision\u2010making can be challenging when considering long\u2010term feeding options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To consolidate best practice and begin working towards developing a pathway for patients with cognitive impairment and dysphagia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>A survey was conducted among post\u2010acute stroke units in Wales to determine current practices and identify variations in the management of this patients group. We invited all stroke rehabilitation units that were part of a stroke\u2010specific pathway in Wales to participate (<jats:italic>n<\/jats:italic> = 9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes &amp; Results<\/jats:title><jats:p>Of the seven units that provided data, we identified great variety in experience and practice. Conversion to oral intake varied from 21.3% to 81.8% and to eating and drinking with acknowledged risk varying from 0.0% to 66.7%. Only one centre had a pathway specifically tailored to cognitively impaired nasogastric (NG)\u2010fed patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Implications<\/jats:title><jats:p>This heterogeneity in practice and experience highlights a need to develop formal pathways for the weaning of NG feeding with these patients. Any variation in patient outcomes for those with both cognitive impairment and dysphagia compared with those unaffected need to be explored. We present a model pathway for conversion from NG feeding for patients with cognitive impairment. We also propose future work to develop a patient\u2010centred evidence base to inform practice for patients with dysphagia and cognitive impairment post\u2010stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is limited research on how to achieve the best outcome for patients with stroke and coexistent cognitive impairment. Clinical experience of the authors would suggest that the dated evidence around appetite and NG feeding might need to be updated to allow the prospect of swallowing recovery in this group to be optimized.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds to the existing knowledge<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is often uncertainty in cases of post\u2010stroke survivors who have cognitive impairment about how best to approach the scenario of feeding if dysphagia exists. This pathway incorporates the current guidance and recommendations in a structured way with a practical approach to the weaning of parenteral feeding to allow those guidelines to implemented as intended.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the potential or actual clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is a possibility that the implementation of this pathway in to clinical practice will ensure that healthcare professionals working with post\u2010stroke survivors who have cognitive impairment can offer a patient\u2010centred, holistic management plan.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.70031","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T09:34:02Z","timestamp":1743845642000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A survey of current practice for post\u2010acute stroke patients with cognitive impairment requiring nasogastric feeding\u2014A proposed management pathway"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0551-7792","authenticated-orcid":false,"given":"Benjamin J.","family":"Jelley","sequence":"first","affiliation":[{"name":"Stroke Rehabilitation Centre Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Blackhouse","sequence":"additional","affiliation":[{"name":"Stroke Rehabilitation Centre Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2017.1398482"},{"key":"e_1_2_9_3_1","unstructured":"British Dietetic Association. (2022).Eating and drinking difficulties in dementia | British Dietetic Association (BDA) [Internet]. 2021 [cited 2022 Dec 2]. Available from:https:\/\/www.bda.uk.com\/resource\/eating\u2010and\u2010drinking\u2010difficulties\u2010in\u2010dementia.html."},{"issue":"4","key":"e_1_2_9_4_1","first-page":"208","article-title":"Weaning patients with dysphagia from tube feeding to oral nutrition: A proposed algorithm","volume":"59","author":"Buchholz A.C.","year":"1998","journal-title":"Canadian Journal of Dietetic Practice and Research"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0884533611405795"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0115426506021006576"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.095414"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta10020"},{"key":"e_1_2_9_9_1","unstructured":"Intercollegiate Stroke Working Party. (2016).Royal College of Physicians: National Clinical Guideline for Stroke (5th Edition)."},{"key":"e_1_2_9_10_1","unstructured":"International Dysphagia Diet Standardisation Initiative (IDDSI). (2023).IDDSI\u2014IDDSI Framework [Internet]. 2019 [cited 2023 Jan 26]. Available from:https:\/\/iddsi.org\/framework\/."},{"key":"e_1_2_9_11_1","unstructured":"National Institute for Health and Care Research. (2017).Nutrition support for adults: oral nutrition support enteral tube feeding and parenteral nutrition (CG32)."},{"key":"e_1_2_9_12_1","unstructured":"National Institute for Health and Care Research. (2022).Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128)."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.7.1200"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2016-001408"},{"key":"e_1_2_9_15_1","unstructured":"Welsh Government. (2017).2017\u20132020 Stroke delivery plan."}],"container-title":["International Journal of Language &amp; Communication Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1460-6984.70031","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T10:31:39Z","timestamp":1747996299000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1460-6984.70031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/1460-6984.70031"],"URL":"https:\/\/doi.org\/10.1111\/1460-6984.70031","archive":["Portico"],"relation":{},"ISSN":["1368-2822","1460-6984"],"issn-type":[{"type":"print","value":"1368-2822"},{"type":"electronic","value":"1460-6984"}],"subject":[],"published":{"date-parts":[[2025,4,3]]},"assertion":[{"value":"2023-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70031"}}