Regaining Swallowing Function Post-Stroke: A Comprehensive Guide

Swallowing difficulties, or dysphagia, are a common occurrence after a stroke, affecting over 40% of survivors. Dysphagia can cause serious complications such as malnutrition, dehydration, and aspiration pneumonia. However, it is highly treatable, and most patients can recover within a few weeks or months.

Dysphagia is caused by damage to the parts of the brain that control the throat muscles, resulting in impaired control over the muscles in the throat responsible for swallowing. This can lead to food or liquid entering the airway and lungs, causing aspiration pneumonia.

Treatment for dysphagia typically involves working with a speech-language pathologist (SLP) to develop a rehabilitation program, which may include swallowing exercises, compensation techniques, and complementary treatments such as electrical stimulation and acupuncture. Most people are able to swallow safely again within the first few weeks, but a small number of people have problems that last longer.

During recovery, it is important to make changes to your diet, such as eating soft or pureed foods and drinking thickened liquids, to ensure safe swallowing and adequate nutrition. Family and friends can also play a crucial role in helping individuals with dysphagia by providing support and following the recommendations of the SLP.

Recognising signs of dysphagia

Dysphagia is a common condition after a stroke, affecting almost half of stroke survivors. It is a swallowing disorder that can range in severity from minor difficulties to a complete inability to swallow. It is important to recognise and manage dysphagia to prevent potential complications such as poor nutrition, pneumonia, and disability. Here are some signs and symptoms associated with dysphagia:

• Coughing during or after eating or drinking
• Gagging or choking when swallowing
• Frequent throat clearing after eating or drinking
• Wet or gurgly voice during or after eating or drinking
• Sensation of food being stuck in the throat or chest
• Difficulty chewing or controlling food in the mouth
• Prolonged mealtimes or difficulty swallowing
• Inability to keep food or liquid in the mouth
• Food or liquid leaking from the mouth
• Difficulty breathing after meals

If you or someone you know is experiencing any of these symptoms, it is important to seek medical advice. A speech-language pathologist or a speech and language therapist can evaluate swallowing function and recommend appropriate interventions to improve swallowing ability.

Dietary changes to help with dysphagia

Dysphagia, or difficulty swallowing, can be caused by a stroke. This can lead to serious health issues such as malnutrition, dehydration, and pneumonia. Dietary changes can help manage dysphagia and reduce the risk of these complications. Here are some dietary modifications that can aid in improving swallowing function:

• Modify the texture of food: Soften, chop, or puree solid foods to make them easier to swallow. This can include eating bite-sized or pureed food.
• Adjust the consistency of liquids: Thicken drinks and liquids to make them safer to consume. This can be done by adding flavourless gels, gums, or powders. Pre-thickened liquids are also available for purchase.
• Change food temperature: Consume cold foods or allow hot foods to cool down before eating, as hot foods and drinks can be challenging to swallow.
• Eat smaller, more frequent meals: Instead of three large meals, opt for smaller portions throughout the day. This can be beneficial if you're having trouble concentrating or get tired quickly.
• Take your time: Eat and drink slowly, and take small bites and sips. Chew your food thoroughly and swallow twice after each mouthful to ensure nothing is left in your mouth.
• Maintain good posture: Sit up straight with your back straight while eating or drinking. This helps prevent choking and reduces the risk of food or liquid entering your airway.
• Minimise distractions: Create a calm and focused environment for mealtimes by turning off the TV or moving to a quiet space. This helps you concentrate on swallowing safely.
• Practice swallowing exercises: Work with a speech-language pathologist to learn and practice swallowing exercises. These exercises can help improve muscle control and coordination, making it easier to swallow.

It is important to work closely with a speech-language pathologist or a specialist to determine the best dietary changes for your specific needs. They will assess your swallowing function and provide guidance on the types of food and liquid consistencies that are safe for you. Additionally, they may recommend swallowing maneuvers or other complementary treatments to improve your swallowing ability.

Exercises to strengthen swallowing muscles

Swallowing exercises can help improve communication between the brain and the muscles involved in swallowing. These exercises can help train the associated muscles and improve oral motor control. Consistent and repetitive practice of swallowing exercises can promote adaptive rewiring in the brain through a process known as neuroplasticity. This allows the brain to recover functions that were impaired or lost due to stroke-related brain damage. Here are some exercises to strengthen the swallowing muscles:

Tongue Hold Exercises

Sit upright and tilt your head back slightly. Press the tip of your tongue against the roof of your mouth, just behind your front teeth, and hold it for a few seconds. Now, try swallowing while keeping your tongue pressed against the roof of your mouth. This exercise helps strengthen the muscles in the back of your throat and improves tongue control.

Expiratory Muscle Strength Training (EMST)

Take a deep breath and then exhale through a straw into a glass of water. Blowing out through the straw provides resistance, strengthening the muscles involved in swallowing.

Neck Strengthener (Shaker Exercise)

Lie flat on your back and raise your head as if trying to look at your toes. Keep your shoulders touching the floor or mat and then relax your head back down. Repeat this exercise 5 times. This exercise strengthens the suprahyoid muscles involved in swallowing and helps open the upper part of the oesophagus, making it easier for food to enter.

Tongue Forward and Upward Pushing

For tongue forward pushing, push your tongue against the top of your mouth, where your front teeth meet your palate. Press and hold for a few seconds, then release. Repeat this 5 times.

For tongue upward pushing, touch the tip of your tongue to the top of your mouth, where your teeth meet the inside of your mouth. Now, slide your tongue back about an inch and push it upward, holding for a few seconds before releasing. Repeat this 5 times. Tongue upward pushing helps activate the muscles used in swallowing and improves coordination.

Effortful Swallow

This exercise directly involves the act of swallowing. Practice swallowing hard while pushing your tongue against the top of your mouth. Pretend you are swallowing a golf ball and squeeze all the muscles involved in the swallow. Repeat this exercise 10 times.

Remember to consult with your medical team or speech-language pathologist before attempting any new swallowing exercises. They can guide you on which exercises are most suitable for your specific needs and ensure your safety.

Alternative feeding methods

If you are experiencing dysphagia after a stroke, it is important to consult a medical professional, such as a speech-language pathologist (SLP) or speech and language therapist, who can advise on the best alternative feeding methods for your specific case.

• Soft or pureed foods: Eating softer foods that are easier to chew and swallow can help prevent malnutrition. Pureed foods can be made at home or delivered by meal services.
• Thickened liquids: Thickened drinks move slower than thin liquids, reducing the risk of choking or aspiration. These can be made using special powders or by chilling or flavouring the liquid to make it more enjoyable.
• Modified food and liquid consistency: This can involve adjusting the temperature of food and drinks, making chilled options easier to swallow. It can also mean modifying the texture of food, such as softening, chopping or pureeing it.
• Small bites and sips: Taking small bites of food and sips of liquid can aid swallowing and reduce the risk of choking.
• Positioning: Sitting up straight when eating or drinking can aid swallowing and reduce the risk of choking.
• Avoiding distractions: Focusing on eating without distractions can help ensure safer swallowing.
• Tube feeding: In more severe cases, a feeding tube may be recommended. This involves inserting a tube through the nose and into the stomach (nasogastric tube) or directly into the stomach through the skin (percutaneous endoscopic gastrostomy tube). Tube feeding can be done at home with the help of a feeding machine, and community nurses can provide support.

It is important to work closely with a medical professional to determine the best alternative feeding methods for your specific needs and to monitor your nutrition and health.

Dysphagia's impact on quality of life

Dysphagia, or difficulty swallowing, can have a significant impact on the quality of life of stroke survivors. It can lead to serious complications such as malnutrition, dehydration, and aspiration pneumonia, which can be life-threatening. The inability to swallow can also result in weight loss and inadequate nutrient intake, hindering the body's and brain's recovery after a stroke.

Dysphagia affects the social and psychological aspects of eating and drinking. It can cause embarrassment, especially when eating in front of others, and lead to a feeling of being left out during family mealtimes or social gatherings involving food and drinks. This can take a toll on the mental health and well-being of stroke survivors, requiring support from family, friends, or support groups.

The need for alternative feeding methods, such as soft foods, thickened liquids, or tube feeding, can also impact the quality of life. Tube feeding, in particular, can be uncomfortable and inconvenient, affecting sleep quality. It may also be challenging for those living alone to manage tube feeding at home, although most people eventually adjust well to this method.

Rehabilitation and treatment for dysphagia are crucial to improving the quality of life of stroke survivors. Speech-language pathologists play a vital role in diagnosing and treating swallowing disorders, providing exercises, compensation techniques, and complementary treatments to help individuals regain their swallowing function and improve their nutrition and overall well-being.

Frequently asked questions