During the emergency department management of all stroke patients, an NPO (nothing by mouth) status should be maintained until a formal swallow study can be performed to determine whether there is dysphagia.
The best predictor of dysphagia (swallowing difficulty) in a stroke patient is the presence of dysarthria (motor speech abnormality).
While the absence of a gag reflex, may suggest some degree of dysphagia, remember that about 10 to 15% of people lack a gag reflex.
