Excerpted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August 2003 (Science update August 2009)

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.

• 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.