Brain-Swallowing Strokes: Understanding The Devastating Impact

how can a stroke swallow your brain

A stroke can cause a swallowing disorder called dysphagia, which affects more than half of stroke survivors. This occurs when the stroke damages the parts of the brain that coordinate the many muscles involved in swallowing. If left untreated, dysphagia can lead to serious health issues such as malnutrition, dehydration, and pneumonia. However, it is highly treatable, and most patients recover within a few weeks or months.

Characteristics Values
Prevalence Almost half of people who have a stroke will have swallowing problems at first
Recovery Swallowing problems often improve quickly, with most people able to swallow safely again within the first few weeks
Causes Damage to parts of the brain that coordinate the many different muscles involved in swallowing
Effects Food and drink may enter the airway and lungs, which can lead to aspiration and pneumonia
Screening All stroke patients should have their swallowing assessed within four hours of arriving at the hospital
Treatment Speech and language therapy, changes to diet and drinking habits, tube feeding

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How a stroke can cause dysphagia (a swallowing disorder)

A stroke can affect the way food moves in your mouth and how well you can swallow. This is called dysphagia, or difficulty in swallowing, and it is a common clinical problem. Almost half of people who have a stroke will have swallowing problems initially, but it often improves quickly.

Swallowing is a complicated task that requires the brain to coordinate many different muscles. If a stroke damages the parts of the brain that control this, it will affect your ability to swallow. There are three types of swallowing: subconscious swallowing (which occurs approximately once every minute); reflexive swallowing (which is an airway-protective mechanism triggered by a sudden stimulus); and nutritional, or volitional, swallowing (which occurs when eating). When volition is involved, there is a swallowing network in the cerebral cortex that includes the insula, cingulate gyrus, prefrontal gyrus, somatosensory cortex, and precuneus regions. All of these areas are activated when a person takes a volitional, or nutritional, swallow. When a person has a stroke, one or more of these areas is usually damaged, which disrupts the swallowing network and debilitates the command center. Therefore, swallowing becomes impaired.

Dysphagic symptoms can also occur if a stroke affects the brain stem, such as with lacunar infarcts of the brain stem or a hemorrhage in this region. Any neurologic or muscular damage along the deglutitive axes can cause dysphagia. Thus, central causes of dysphagia in stroke patients include damage to the cortex or brain stem, and peripheral causes include damage to the nerves or muscles involved in swallowing. Swallowing abnormalities can develop when these damages result in malfunction, discoordinated function, or lack of function of the neuromuscular apparatus.

Dysphagia can cause problems with eating and drinking. Food or drink might go down the wrong way and get into your lungs. This is called aspiration. Normally, aspiration causes a violent cough, but a stroke can reduce sensation. In this case, you may not know you're aspirating (silent aspiration). Aspiration can be very serious as your mouth contains high numbers of bacteria (germs) and if these enter the airway, it can lead to pneumonia.

Signs of dysphagia include coughing or choking when eating or drinking, bringing food back up (sometimes through your nose), food or drink going down the wrong way, feeling that food is stuck in your throat, not being able to keep food or drink in your mouth, having a croaky or 'wet' sounding voice, and taking a long time to swallow or finish a meal.

If not identified and managed, dysphagia can lead to poor nutrition, pneumonia, and disability.

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The impact of dysphagia on nutrition and health

Dysphagia, or difficulty swallowing, can have a significant impact on a person's nutrition and health. It can lead to poor nutrition, weight loss, malnutrition, dehydration, and an increased risk of developing pneumonia.

Dysphagia affects more than 50% of stroke survivors. While most patients recover their swallowing function within a few days or weeks, some face long-standing swallowing problems that put them at risk for serious health complications. These complications include aspiration pneumonia, malnutrition, dehydration, and a significant decrease in quality of life.

Aspiration is a common problem for people with dysphagia. It occurs when food, liquid, or saliva enters the airway and lungs instead of the oesophagus. Aspiration can cause violent coughing, but a stroke can reduce sensation, leading to silent aspiration where the person may not be aware they are aspirating. Aspiration can lead to pneumonia as the mouth contains high numbers of bacteria that, if aspirated, can cause infection in the lungs.

In cases where dysphagia severely impacts a person's ability to eat and drink, a feeding tube may be recommended to ensure adequate nutrition and hydration. This involves delivering liquid food directly into the digestive system through a tube.

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How aspiration occurs and its dangers

Aspiration is a common problem for people with dysphagia, a swallowing disorder that affects more than 50% of stroke survivors. It occurs when something you've swallowed enters the airway and lungs. Normally, aspiration causes a violent cough, but a stroke can reduce sensation, and you may not know you're aspirating (silent aspiration).

The stroke team watches carefully for any signs of aspiration and pneumonia. Everyone who has had a stroke should have their swallowing assessed within four hours of arriving at the hospital, and you shouldn't eat, drink, or take any medications by mouth until your swallowing has been assessed.

If you can't swallow correctly, food, drink, and saliva may enter your airway and lungs. Your mouth contains high numbers of bacteria, and if these enter the airway, it can lead to pneumonia. Therefore, it's essential that any changes to your swallowing are spotted early to avoid this potentially serious complication.

The dangers of aspiration include:

  • Lung infections (pneumonia): After a stroke, your risk of a lung infection increases.
  • Malnutrition and dehydration: Dysphagia can make it difficult to consume adequate nutrition and fluids, leading to malnutrition and dehydration.
  • Significant decrease in quality of life: The inability to eat at a normal speed and the constant coughing and choking associated with dysphagia can negatively impact an individual's quality of life.

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How to identify and treat dysphagia

Dysphagia is the medical term for difficulty swallowing. It is a common issue after a stroke, affecting almost half of people who have experienced a stroke. It can be caused by damage to the swallowing network in the cerebral cortex, which includes the insula, cingulate gyrus, prefrontal gyrus, somatosensory cortex, and precuneus regions.

Identification

  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • A sensation that food is stuck in your throat or chest
  • Persistent drooling of saliva
  • Weight loss and repeated chest infections over time

Treatment

  • Speech and language therapy: A speech-language pathologist (SLP) or speech and language therapist can assess your swallowing ability and provide treatment. They may recommend swallowing exercises and techniques, such as changing your posture or using positioning techniques to redirect the movement of food.
  • Modify food and liquid consistency: Adjust the texture of food by softening, chopping, or pureeing, and change the thinness or thickness of liquids.
  • Feeding tube: If it is not safe for you to swallow, a feeding tube may be suggested to meet your nutritional needs. There are two main types: nasogastric tubes, which are temporary and inserted through the nose, and percutaneous endoscopic gastrostomy (PEG) tubes, which are more permanent and inserted directly into the stomach.
  • Dietary changes: Your diet may need to be adjusted to include softer foods that are easier to chew, and thickened drinks to make them safer to swallow.
  • Rehabilitation: An SLP can teach you exercises to strengthen your swallowing muscles, such as learning to take smaller bites and chew food thoroughly.

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The role of speech-language pathologists in dysphagia management

A stroke can cause a swallowing disorder called dysphagia, which can lead to serious health issues if not identified and managed properly. Speech-language pathologists play a crucial role in the management of dysphagia, providing services that include evaluation, diagnosis, and rehabilitation.

During the evaluation phase, speech-language pathologists typically begin with a bedside examination to assess the patient's ability to swallow safely. This may be followed by a video-fluoroscopic study or a modified barium swallow test, which allows for a more detailed examination of the neuromuscular components of the swallow while minimising the risk of aspiration.

Once the evaluation is complete, the speech-language pathologist will make recommendations for the patient's feeding regimen. This includes determining the appropriate diet level, the amount of intake per swallow, positioning techniques, and swallowing exercises. Thermal stimulation, oromotor control exercises, laryngeal adduction training, and compensatory swallowing techniques may also be recommended.

The role of the speech-language pathologist is to ensure that patients receive proper nutrition while minimising the risk of aspiration. They collaborate with other healthcare professionals, such as nurses, to screen and manage dysphagia, especially in acute care settings.

In addition to evaluation and diagnosis, speech-language pathologists provide therapeutic interventions aimed at improving oropharyngeal function. These interventions may include compensatory procedures and exercises to strengthen the swallowing muscles. They also educate patients and their families about safe swallowing techniques and the importance of adhering to the recommended diet and positioning techniques.

Overall, the role of speech-language pathologists in dysphagia management is crucial for improving patients' swallowing function, preventing complications, and ensuring adequate nutrition. Their expertise in evaluating, diagnosing, and treating swallowing disorders makes them an integral part of the healthcare team managing stroke patients with dysphagia.

Frequently asked questions

Dysphagia is the medical term for difficulty swallowing. It is a common issue after a stroke, affecting more than 50% of survivors. It can also be caused by nervous system and brain disorders, muscle disorders, and physical blockages in the throat.

Symptoms include coughing or choking when eating or drinking, regurgitating food or liquid, sensations of food being stuck in the throat, changes in vocal quality, drooling, and difficulty coordinating breathing and swallowing.

Dysphagia is caused by damage to the parts of the brain that coordinate the many muscles involved in swallowing. This can include damage to the cerebral cortex, brain stem, or nerves and muscles involved in swallowing.

Treatment for dysphagia can include medications, changes to eating habits, and procedures. A speech-language pathologist can assess the patient's ability to swallow and provide treatment. This may include exercises to strengthen swallowing muscles, changing how the patient eats and drinks, and using aids to make eating and drinking easier.

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