While dysphagia and difficulty swallowing can be caused by a variety of conditions, stroke is one of the most common causes of dysphagia. The process of swallowing food or liquid is actually a very complex function of the central nervous system, requiring precise coordination of a number of different muscle groups. Following a stroke, actions that we normally take for granted can become difficult or impossible until the body and mind recover. A stroke can cause nerve damage, which can in turn impair swallowing. According to the National Stroke Association, over 70% of stroke survivors have experienced dyphagia following a stroke. In the United States alone, nearly 800,000 people suffer a stroke each year. Strokes most often result in what is termed oropharyngeal dysphagia – difficulty in moving food from the mouth into the esophagus. Symptoms of this type of dysphagia can include:
- Trouble starting a swallow
- Coughing while swallowing
- Gagging while swallowing
- Food caught in the lungs
- Food coming out of the nose
These symptoms can be distressing, and the road to recovery is often a long one. Following a stroke, a speech-language pathologist (a medical professional who specializes in disorders like dysphagia) may examine a stroke survivor to assess their swallowing ability. They will take a look at how well the muscles in the mouth move, they will listen to the patient’s voice for signs of trouble with the patient’s voicebox, and they may be given small samples of food and liquid to swallow. Based on these observations, the speech-language pathologist will decide whether it is safe for the patient to swallow whole food, or whether the patient will require a specialized diet during recovery. While a feeding tube may be required in extreme cases, sometimes the speech-language pathologist will prescribe stroke victims a restricted diet, or a diet of thickened liquids that are easier to manage. Some patients are able to swallow properly with minor adjustments to technique, such as taking smaller sips of liquid.
For patients in recovery, doctors may begin a course of swallowing therapy and exercises to strengthen the muscles responsible for dysphagia, and to train the patient to adjust their posture to make swallowing easier. Swallowing therapy is particularly effective in stroke patients, who show high levels of ability in “retraining” their muscles and nervous system to swallow more effectively after a stroke. The patient may also be given a prescription for certain muscle relaxers to help open the throat. While surgery is occasionally an option considered for stroke survivors, it is rarely recommended. Special care must be taken when addressing difficulties with swallowing in stroke patients with cognitive difficulties, as they may be unable to adjust to modified swallowing instructions. Caregivers should be mindful of possible anxiety caused by dysphagia symptoms, and should be prepared to assist with proper feeding techniques.
For more information on dysphagia in stroke victims, please visit the National Stroke Association.