After talking about dysphasia in many of our topics before, we become quite familiar with this subject; however, how much do we know about its twin brother: dysphagia? After a stroke, the damage to speech and movement is usually obvious. But for some stroke survivors, having trouble swallowing can be an invisible — but extremely disabling. A swallowing disorder called dysphagia often occurs as a result of stroke. Dysphagia may occur in up to 65 percent of stroke patients. If not identified and managed, it can lead to poor nutrition, pneumonia and increased disability.
Following a stroke, weakened muscles in the mouth or throat, a loss of sensation in the tongue, poor muscle coordination, or the inability to cough can impair swallowing. For example, the tongue is a key participant in the mechanism of swallowing. It moves food around the mouth and helps to form an adequate food bolus which can be handled by the rest of the swallowing apparatus. The tongue is also needed for transporting this food bolus back toward the pharynx. If half of the tongue is damaged, it may be difficult for a person to initiate the swallowing reflex effectively by moving food to the back of the throat. Beyond the tongue, if certain muscles are affected, they may not close off the airway enough to prevent food or liquid from leaking into the lungs. Weakened muscles may also delay swallowing or result in an incomplete swallow.
What are the typical signs of Dysphagia? You may want to refer to an expert or a speech-language therapist if you experience these:
- Excessive drooling
- Food falling out of the mouth
- Clumsiness in getting food to the back of the mouth
- Difficulty starting or completing a swallow
- Food remaining in the mouth after swallowing
- Frequent throat clearing, coughing or choking after eating or drinking
- Voice that sounds wet or gurgling
- Complaints of food or drink sticking in throat
The condition is diagnosed by a series of exam. A speech-language therapist will evaluate how well the muscles in the mouth move; he/she will listen to the patient’s voice for an idea of how the voice-box is working. The patient may be given food and liquid to swallow, while the therapist will observe the internal swallowing skills, to see if there’s a problem or delay. For instance, if all the muscles on one side are weak or paralyzed, it’s going to be difficult to chew. They will have something sticking on the right side of the mouth; if swallowing is delayed, it may indicate a problem, normally it takes about a second to swallow, even a small disruption places that person at risk for aspiration into the lungs.
The speech-language therapist will then suggest ways of managing a patient’s swallowing problems. To avoid aspirating liquid, for example, making a simple change in head position may work, like turning it more to one side, or tucking in the chin. The therapist can also teach the patient ways to strengthen the muscles involved in swallowing. A therapist also recommends tips for caregivers or family members to protect the patient from aspiration, such as:
- Make sure that the person with dysphagia sits up in a chair at a 90-degree angle while eating, and continues to sit upright for at least 30 minutes after a meal.
- Don’t use straws which make it too easy for liquid to leak into the airway from the back of the throat
- Allow plenty of time for meals
- Encourage smaller bites and sips
- Reduce distractions like television, music and number of people in the room
- Make sure the person has good oral hygiene
Eating is one of life’s simple pleasures. With proper treatment, most stroke survivors who struggle with swallowing problems will be able to enjoy eating again. “Even stroke survivors who may have to stay on feeding tubes for an extended time don’t have to be completely deprived of their favorite foods”, says a speech and language therapist at St. Mary’s Medical Center Acute Rehabilitation unit in San Francisco, “We can work with them so they can tolerate a small amount of the food they love”…