
A stroke can affect a person's ability to swallow, which is known as dysphagia. Dysphagia is a common condition, affecting almost half of stroke patients initially. It can cause serious complications such as malnutrition, dehydration, and pneumonia if left untreated. Stroke patients with dysphagia may experience coughing or choking when eating or drinking, regurgitation of food or liquid, sensations of food being stuck in the throat, and changes in vocal quality. The condition is highly treatable, and most patients recover within weeks or months. Treatment typically involves a speech-language pathologist and may include exercises such as the Shaker Exercise and Effortful Swallow.
Characteristics | Values |
---|---|
Prevalence | Almost half of stroke patients experience swallowing problems, with 50-60% of patients developing dysphagia. |
Risk Factors | Damage to the parts of the brain that coordinate swallowing, such as the cerebral cortex (insula, cingulate gyrus, prefrontal gyrus, somatosensory cortex, and precuneus regions) and brain stem. |
Symptoms | Coughing, choking, regurgitating food, swallowing food down the wrong tubes, sensation of stuck food in the throat, drooling, throat clearing, changes in vocal quality, inability to coordinate breathing and swallowing. |
Complications | Malnourishment, dehydration, pneumonia, weight loss, malnutrition, and a decrease in quality of life. |
Diagnosis | A swallowing assessment is recommended within four hours of arriving at the hospital. This may include a videofluoroscopy or a fibreoptic endoscopic evaluation of swallowing (FEES). |
Treatment | Treatment typically involves a speech-language pathologist and may include exercises such as the Shaker Exercise and Effortful Swallow. Dietary changes are also recommended, such as thickened drinks and soft or pureed food. |
What You'll Learn
- Dysphagia: the medical term for swallowing difficulties post-stroke
- Aspiration: when swallowed food enters the lungs, which can lead to pneumonia
- Therapeutic approaches: exercises to strengthen the throat, face and mouth muscles
- Dietary changes: soft foods, thickened drinks, and pureed meals
- Tube feeding: nasogastric (NG) tubes and percutaneous endoscopic gastrostomy (PEG) tubes
Dysphagia: the medical term for swallowing difficulties post-stroke
Dysphagia, or swallowing difficulties, is a common complication after a stroke, affecting over half of stroke survivors. It can have serious consequences if left untreated, including malnutrition, dehydration, and pneumonia. However, with proper treatment, most stroke patients can recover within a few weeks or months.
Symptoms
The following symptoms may indicate dysphagia:
- Coughing or choking when eating or drinking
- Regurgitating food or liquid, sometimes through the nose
- Swallowing food or liquid down the wrong tubes (known as aspiration)
- Sensation of food stuck in the throat
- Food or liquid remaining in the mouth after swallowing
- Changes in vocal quality, such as a wet or gurgling sound
- Drooling or inability to control saliva
- Coughing and throat clearing after eating or drinking
- Difficulty coordinating breathing and swallowing
Diagnosis and Treatment
If you are experiencing any of these symptoms after a stroke, it is important to seek medical attention. A speech-language pathologist (SLP) will typically be involved in the diagnosis and treatment of dysphagia. Diagnostic tests may include a video fluoroscopic examination, where the patient swallows contrast materials of different sizes and consistencies, or a videoendoscopic examination, where a tiny endoscope is inserted through the nostril to visualize the swallowing process.
Treatment for dysphagia will depend on the specific deficits identified during the evaluation. Treatment approaches may include:
- Maneuvers to direct food away from the weak side
- Changes in posture to reduce the likelihood of aspiration
- Modifying the consistency and volume of food to improve bolus transit and reduce aspiration
- Rehabilitation exercises to strengthen the swallowing muscles, such as the Shaker exercise or Mendelsohn maneuvers
In addition, patients may be advised to make changes to their diet, such as thickening drinks or eating soft or pureed foods, to facilitate safer swallowing.
Prognosis
With proper treatment, most stroke patients with dysphagia can recover within a few weeks to months. However, a small number of people may have long-term or permanent swallowing difficulties. Even in these cases, most people can still live full lives and enjoy eating and drinking with some adjustments.
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Aspiration: when swallowed food enters the lungs, which can lead to pneumonia
Aspiration is a common problem for people with dysphagia, a swallowing disorder that can be caused by a stroke. It occurs when something you have swallowed enters the airway and lungs. Normally, aspiration causes a violent cough, but a stroke can reduce sensation, and you may not realise you are aspirating (silent aspiration). If not identified and managed, dysphagia can lead to pneumonia.
Aspiration pneumonia can occur if a person breathes something into their lungs instead of swallowing it. Germs, food particles, saliva, vomit, or other substances may infect the airways. It is different from regular pneumonia, which is caused by a virus, bacteria, or fungus that infects a person and then spreads to the lungs.
Aspiration pneumonia is caused by bacterial infection. The substance that has been aspirated, such as food, saliva, or vomit, brings in bacteria, which can cause the infection. Healthy lungs can usually handle the bacteria from these types of accidents and get rid of them through coughing. However, aspiration can be very serious as the mouth contains high numbers of bacteria, and if these enter the airway, it can lead to pneumonia.
People who have trouble coughing, are less alert, are already ill, or have compromised immune systems are more prone to aspiration pneumonia. It is more common in people with existing health complications. It is less common in healthy individuals.
Aspiration pneumonia can cause a range of symptoms, including shortness of breath or difficulty breathing. Anyone with these symptoms should contact their doctor immediately for diagnosis and treatment.
Aspiration pneumonia can be treated with antibiotics to help clear the infection and avoid serious complications. Treatment often also involves the use of oxygen.
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Therapeutic approaches: exercises to strengthen the throat, face and mouth muscles
Therapeutic approaches and exercises can help stroke patients strengthen their throat, face, and mouth muscles, and improve their swallowing function. Here are some of the most effective exercises:
Tongue Stretching and Movement
- Stick out your tongue and move it in different directions (up, down, left, and right) to target different muscles.
- Try to touch the corners of your mouth with your tongue and hold for a few seconds in each position.
- Reach your tongue up towards your nose, then down towards your chin.
Neck Strengthening
The "shaker exercise" targets the neck muscles involved in swallowing, including the suprahyoid muscles. Lie flat on your back, then raise your head as if trying to look at your toes while keeping your shoulders on the floor or mat. Relax your head back down and repeat.
Chin Tuck
Place a small, soft ball under your chin and press your chin down, holding it there for 5-10 seconds. This exercise helps to reduce the likelihood of aspiration (food entering the airway).
Tongue Hold
Stick out your tongue and hold it gently between your teeth. Practice swallowing with your tongue in this position. This improves the strength and movement of the muscles at the back of your throat.
Effortful Swallow
This exercise involves practising swallowing hard while pushing your tongue against the top of your mouth. Some people find it helpful to pretend they are swallowing a golf ball, squeezing all the muscles involved in the swallow.
Pitch Gliding
Take a deep breath and say the sound "eeee" in a low pitch, then gradually slide your voice into a high pitch and hold for a few seconds. This exercise focuses on raising your larynx (voice box).
Breathing Exercises
Take a slow, deep breath and hold it for a few seconds before exhaling. Repeat this a few times. Then, try inhaling deeply and quickly, followed by a slow and deliberate exhale.
Blowing Through a Straw
Take a deep inhalation, then exhale by blowing through a straw placed in a glass of water. The resistance of the water helps to strengthen the muscles involved in swallowing.
It is important to consult with a speech therapist to determine which exercises are most appropriate for your specific needs and to ensure safe practice.
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Dietary changes: soft foods, thickened drinks, and pureed meals
A stroke can cause a swallowing disorder called dysphagia, which can lead to poor nutrition, pneumonia, and disability if not identified and managed. Dysphagia occurs when the brain fails to activate muscle reflexes at the back of the throat quickly enough, causing food or liquid to enter the airway and lungs. This is known as aspiration, which normally causes a violent cough, but a stroke can reduce this sensation.
To prevent aspiration, people who have had a stroke may need to make dietary changes, such as consuming soft foods, thickened drinks, and pureed meals. Here are some detailed instructions for these dietary changes:
Soft Foods
Soft foods are essential for people with dysphagia as they are easier to chew and swallow. Examples of soft foods include:
- Eggs: Soft and easily adaptable, eggs are a good source of protein and can be prepared in a variety of ways.
- Greek Yogurt: A good source of calcium and protein, Greek yogurt is also a softer option that can be included in breakfast or as a snack.
- Avocados: Avocados are rich in oleic acid, which is important for optimal performance in the areas of the brain responsible for processing information.
- Fish: Fatty fish like salmon contain omega-3 fatty acids, which help maintain brain-derived neurotrophic factor levels and promote neuroplasticity.
Thickened Drinks
Thickened drinks help prevent liquids from entering the airway and lungs. People with dysphagia may need to add thickeners to their drinks or consume commercial thickeners. It is important to note that thickeners may not work with fizzy drinks.
Pureed Meals
Pureed meals are often introduced initially after a stroke, as they are easy to swallow and reduce the risk of choking. While some people may dislike the texture and appearance of pureed food, it is crucial for ensuring adequate nutrition. Pureed meals can include:
- Mashed potatoes
- Pureed vegetables, such as cabbage or peas
- Pureed meats, such as lamb
It is important to work closely with a speech-language pathologist or a dietitian to determine the best consistency of foods and liquids for safe swallowing and adequate nutrition. These professionals can provide guidance and create a safe list of foods appropriate for the individual's needs.
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Tube feeding: nasogastric (NG) tubes and percutaneous endoscopic gastrostomy (PEG) tubes
Tube feeding is a method of providing nutrition directly into the digestive system through a tube when an individual is unable to swallow safely. This is also known as enteral feeding. This method may be required if the individual is not getting enough nutrition from their diet, which can cause low energy levels and slow down recovery.
There are two main types of feeding tubes commonly used after a stroke: nasogastric (NG) tubes and percutaneous endoscopic gastrostomy (PEG) tubes.
Nasogastric (NG) Tubes
Nasogastric tubes are thin tubes, about as wide as a piece of spaghetti, that are inserted through the nose, down the back of the throat, and into the stomach. Here are some advantages and disadvantages of NG tubes:
- Safer to insert compared to PEG tubes as they are less invasive and do not require sedation.
- Can be uncomfortable for the patient when in place.
- May fall out easily and require regular replacement.
- Some people may not like the appearance of the tube.
Percutaneous Endoscopic Gastrostomy (PEG) Tubes
PEG tubes are inserted directly into the stomach through a small hole in the skin. Here are some advantages and disadvantages of PEG tubes:
- Can be hidden under clothing.
- More difficult to replace if it falls out.
- A sedative is usually given during the insertion procedure, and a doctor or nurse will explain the risks.
- The area around the tube insertion site can become infected.
The decision to use an NG tube or a PEG tube depends on various factors, including the expected duration of tube feeding and the patient's preferences. It is important to discuss both options with the stroke team and family to determine the most suitable choice.
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Frequently asked questions
Dysphagia is a swallowing disorder that affects more than 50% of stroke survivors. It can lead to malnutrition, dehydration, and pneumonia if left untreated.
Symptoms of dysphagia include coughing or choking when eating or drinking, regurgitating food or liquid, sensations of "stuck" food in the throat, changes in vocal quality, drooling, and difficulty coordinating breathing and swallowing.
Treatment for dysphagia typically involves a speech-language pathologist and may include exercises such as the Shaker Exercise and Effortful Swallow. Dietary changes, such as modifying food consistency, are also often recommended.