Swallowing Problems after a Stroke

According to the American Stroke Foundation, swallowing problems after a stroke affect up to 78% of stroke survivors. This condition is known as dysphagia.

Dysphagia can cause life threatening complications like aspiration pneumonia, choking, malnutrition, dehydration, and infection. In addition, swallowing issues can decrease a person’s quality of life due to his inability to eat without choking or coughing.

What Causes Swallowing Problems

Swallowing problems after a stroke result from damage to different regions of the brain that control the swallowing mechanisms. There are three areas of functioning that can be affected:

• Subconscious swallowing which occurs once every minute

• Reflexive swallowing, which protects the airway from the inadvertent drop of food into the pharynx

• Nutritional/Volitional swallowing (eating)

How is Dysphagia Diagnosed?

Because swallowing issues can lead to serious complications, a stroke victim requires prompt evaluation after he is well enough to undergo screening. A speech language pathologist uses the following methods to determine if dysphagia is present and to what degree:

• Observation of patient during mealtime
• Fiberoptic endoscopic evaluation (FEES) — A camera is attached to a thin tube and inserted through the nose
• Video fluoroscopy (VFS) or a modified barium swallow.

Observable Symptoms of Swallowing Challenges

Aspiration occurs when food or liquid enters the airway and lungs resulting in a violent cough. However, a stroke victim may not feel that sensation, and will experience a silent aspiration. Therefore, caregivers should be on alert for the following symptoms in their patients or loved ones:

• Repetitive swallowing
• Drinking extra liquid to wash down food
• Food sticking in the throat
• Liquid coming back up
• Garbled or hoarse voice
• Choking
• Recurrent pneumonia

What is the Treatment for Swallowing Issues?

 A speech language pathologist creates a personalized treatment plan for each individual. The patient will receive a feeding tube if the diagnosis is severe. The rehabilitation program can include exercises to strengthen the muscles used for swallowing, cold swabs or ice applied to swallowing muscles just before swallowing, electrical stimulation of the swallowing muscles.  What one eats is also significant. Difficult to chew foods should be avoided like root vegetables, green leafy vegetables, low water content food (i.e. bread, cake, potatoes) as well as thin liquids such as tea, soup, and juice. Other recommendations for eating include:

• Turn head to one side to protect the airway
• Take small sips of liquid and small bites of food
• Sit up straight
• Eat slowly
• Clear all food from the mouth

Conclusion

Fortunately, with early diagnosis and proper treatment, most patients regain their swallowing function within seven days. Only a small percentage remain dysphagic after six months.