Friday, January 25th, 2019
Dysphagia is a disorder characterized by difficulty swallowing and is extremely common among survivors of stroke and other brain conditions. Dysphagia can lead to life-threatening complications like pneumonia, as well as impede a survivor’s ability to eat and negatively impact their social life. Stroke survivors and their family members need to know the signs of dysphagia, how it is treated, and the who/what/when/where/why of getting help.
Dysphagia is most closely associated with trouble swallowing, but it can impact other related functions. Dysphagia can cause trouble eating, drinking, swallowing, sucking, and even simply protecting the airway from saliva.
Over half of stroke survivors experience dysphagia after their stroke event. Thankfully, the majority of survivors “recover swallowing function within 7 days, and only 11-13% remain dysphagic after six months.”
Swallowing seems simple to people at full health, but it can be extremely difficult if the muscles used in the process are weak or uncoordinated as with what occurs often with a stroke survivor. A stroke can negatively impact the part of the brain that controls the swallowing muscles. Additionally, even if the swallowing muscles were not directly impacted, a stroke can interfere with other motor function that themselves impact swallowing. For example, if a stroke has left a survivor unable to sit up straight, swallowing will consequently be more difficult to do comfortably.
Outside of a few special cases, dysphagia is often temporary and most dysphagic stroke survivors recover fully. Working with experts, like dieticians and speech pathologists, can help survivors manage their dysphagia and improve their ability to swallow safely. Additionally, a dietitian can help ensure the patient is eating the right foods, as some types of food and drink (for example, hard-to-chew foods and thin liquids) are more difficult to swallow than others.
Survivors with dysphagia commonly suffer the stroke complication of aspiration, or the inhaling of food and drink. When a person aspirates, while they are swallowing, whatever they are trying to swallow accidentally enters their airway and lungs. In healthy individuals, this typically triggers a coughing reaction, but in the case of a stroke survivor, sensation is often reduced and the cough reflex does not always present itself. As a result, food or drink ends up in the lungs, sometimes without the survivor even knowing it, a phenomenon known as silent aspiration.
The immediate danger of aspiration is coughing or choking. As food or drink “goes down the wrong pipe,” coughing both signals there is a problem while expelling the material from the airway. However, some stroke survivors have decreased sensitivity and cough reflex, and can choke. If food or drink does enter the airway, beyond the initial risk of choking, the patient is at a longer-term risk of a chest infection or pneumonia.
Any problems or concerns with swallowing should be discussed with medical professionals. In most cases, dysphagia is diagnosed and treated by a speech pathologist. A speech pathologist will usually conduct some sort of swallowing test, to assess the ease and ability of the patient to swallow without choking, and make recommendations from there.
A variety of swallowing exercises are used to help stroke survivors recover from dysphagia after a stroke. Some swallowing exercises for dysphagia are concerned with “the approach to posture maintenance, movement of the oral organs (speed, range of motion, accuracy), and improvement in respiratory function (with the aim of improving expectoration).” Other swallowing exercises are meant to strengthen the pharynx, the cavity behind the nose and mouth that connects them to the esophagus. Some swallowing exercises to condition the throat and mouth:
A robust support system of family and friends can make the aftermath of a stroke and its possible complications, like dysphagia, easier to handle. Primary caregivers should be empowered to identify some telltale signs of a swallowing problem, which can be any change in the way you swallow food, drink or your saliva (spit). Signs can include any of the following while eating or drinking:
Don’t use a straw to drink, unless a speech pathologist has given the OK. When eating or drinking, be sure to sit up in a proper straight-backed position. Focus while eating or drinking, especially in the early stages of recovery. Multitasking while eating might have been second nature before a stroke event, but it’s important to be careful when dealing with dysphagia. Most of all, note the types of food that is simply too challenging for a survivor affected by dysphagia:
Dysphagia is a frustrating and common complication of stroke, and survivors who experience it can be disheartened at first. However, with the right knowledge, mindset, support system, and stroke recovery expertise, a survivor’s dysphagia has every likelihood of improving. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.