Dysphagia

What is Dysphagia?

Dysphagia is the medical term for difficulty swallowing or paralysis of the throat muscles. This condition can make eating, drinking, taking medicine and breathing difficult. Many stroke survivors experience dysphagia or trouble swallowing at some point after a stroke. Difficulty swallowing is most common immediately after a stroke, but usually declines over time.
Guide To Dysphagia - 3D Animations of Swallowing
Symptoms you might experience include:
  • Difficulty starting to swallow
  • Choking when food gets stuck
  • Coughing or gagging while swallowing
  • Liquid coming out of the nose after trying to swallow
  • Food getting caught in the lungs
  • Weak voice
  • Drooling
  • Poor tongue control
  • Loss of gag reflex
Dysphagia should not be confused with painful swallowing or the constant feeling of a lump in the throat.

Can difficulty swallowing be treated?
​
The most common treatment for difficulty swallowing is swallow therapy done with the help of a speech language, occupational, or physical therapist. Some stroke survivors may be candidates for Neuromuscular Electrical Stimulation (NMES). If you show signs of aspiration or have difficulty managing your diet, you may be a candidate for this type of dysphagia therapy.

Exercising the tongue, lips, throat, and mouth can help relax and strengthen the muscles as well as increase their flexibility (examples include tucking the chin or rotating the head).

A speech language therapist can teach special exercises to stimulate the nerves involved in swallowing. These can include changing posture and sitting position, reducing distractions at mealtime, eating slower with smaller amounts of food, and changing food texture.

Some medications, such as muscle relaxers, can help open the throat and make swallowing easier.

Tips to living with dysphagia
​
Dietary changes or changes to the texture or thickness of foods may help with swallowing difficulties. For example, you may be able to chew and swallow smaller pieces so chopping, mincing or puréeing food may make it easier for you to eat. Food should be prepared and consumed correctly to avoid inhaling into the lungs.

Dehydration or not drinking enough is always a risk. Thin fluids, such as water, are harder to swallow changing the thickness with liquid thickeners can be helpful. Ask your healthcare professional for the best plan for your individual needs.



Get the Dysphagia Infographic.
dysphagiainfographic.pdf
File Size: 242 kb
File Type: pdf
Download File
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.

Aspiration
  • Aspiration (inhaling food or drink) is a common problem for people with dysphagia.
  • It occurs when material a person is swallowing enters their airway and lungs; pneumonia may develop.
  • Normally, aspiration would cause a violent cough, but a stroke can reduce sensation.
  • After a stroke, food or liquid could enter the airway/lungs without the survivor being aware of it. This is called silent aspiration.
Testing Swallowing

Speech-language pathologists are trained to test swallowing. The first step is a bedside assessment.

  • While you are in the hospital, nursing personnel may access (test) your ability to swallow. If you "fail" the swallow test, the nursing staff may not be able to allow you to eat until a formal swallow study is done by the speech-language pathologist.
  • The speech-language pathologist will evaluate how well the muscles in the mouth move.
  • The speech-language pathologist will ask questions to see if the patient can remember any techniques they might need to learn.
  • The speech-language pathologist will listen to the patient’s voice for an idea of how the voicebox is working.
  • The survivor may be given food and liquid to swallow.

Efforts to make sure survivors with swallowing problems receive adequate nutrition are taken by the patient’s medical team. If it doesn’t appear safe for them to swallow anything by mouth, they may require tube feeding. 

The swallowing tests give the speech-language pathologist information to help create an individualized treatment plan to help patients regain their swallowing skills.

Treatment Plans
​
Treatment plans generally include exercises to improve coordination of muscle movements in the mouth and throat.

  • A plan may also include techniques to help compensate for lost function.
  • One technique is turning the head to one side to provide better airway protection.
  • Another is taking only small sips of liquid so none splashes into the airway because of poor tongue control.
  • The speech-language pathologist may recommend that survivors change the food and liquids they eat and drink.
  • Some foods may be too difficult to chew.
  • Thin liquids are often hard to swallow safely after a stroke because they move quickly through the mouth and throat.
  • This doesn’t allow enough time for the voicebox to lift, close and move forward to protect the airway. Aspiration may result.
  • Survivors are sometimes given liquids that have been thickened so they move more slowly and stay together.

​Although each treatment plan is unique and designed to meet specific needs, some common precautions may help you swallow more safely.
  • Sit up straight any time you eat or drink.
  • Take small bites and sips.
  • Take your time.
  • Make sure you have cleared all the food from your mouth.
During a survivor’s recovery, the speech-language pathologist continually assesses their progress and determines when it’s safe for them to eat more normal foods.
All About Thickening & Thickened Liquids
The Mechanically Altered Diet
Tweet to @StrokeDontJoke