Swallowing disorders after stroke

Swallowing disorders after stroke increase the risk of complications such as aspiration leading to pneumonia and malnutrition, making rehabilitation intervention crucial.

This article was professionally reviewed by Dr. Lam Nguyen Thuy An, MD, Specialist Level 1, University Medical Center of Ho Chi Minh City - Branch 3.

Overview

- Swallowing disorders are the sensation of food being "stuck" or obstructed from passing through the mouth, throat, or esophagus.

- The incidence of swallowing disorders ranges from 19% to 65% in the post-stroke period.

Symptom

- Coughing or choking while eating or drinking. Coughing and choking may occur simultaneously.

- Food gets stuck in the throat, requiring frequent throat clearing to remove it.

- Drooling.

- Difficulty swallowing or choking while eating, swallowing slowly.

- Changes in voice after eating or drinking (hoarse, booming, slurred...).

- Difficulty chewing or rapid breathing while eating or drinking.

- Weight loss if swallowing difficulties persist.

Complications

- The risk of aspiration leading to pneumonia is the most common complication of swallowing disorders.

- Swallowing disorders are associated with pharyngeal sensory impairment; 100% of patients with swallowing disorders have loss of sensation in one or both pharyngeal sides.

- Poor oral hygiene leads to reduced immunity.

Patients with swallowing disorders are prone to dehydration and malnutrition.

- Reduced quality of life and social isolation.

Nutrition

- Severe swallowing reflex disorders:

* Do not eat or drink by mouth.

* Feeding via gastric tube, percutaneous gastrostomy endoscopy.

* Intravenous nutrition.

- Moderate swallowing reflex disorder:

* Eat soft, smooth foods, drink in small sips, supplement with nutrition via gastric tube or intravenous feeding.

* Individual settings.

- No swallowing reflex disturbances: Eating is normal, however, supervision is still needed the first time.

Treatment

Speech therapists will identify swallowing deficits and then select and combine interventions to restore swallowing function. These interventions include compensatory techniques, swallowing exercises, rehabilitation support, and invasive procedures.

- The appropriate swallowing posture includes: chin flexion and head turning towards the paralyzed side. Chin flexion is used in cases of slow pharyngeal swallowing and reduced airway protection, aiming to narrow the laryngeal entrance, reduce the distance between the epiglottis and the pharyngeal septum, and help the epiglottis close more tightly.

- Head-lifting exercise: This exercise aims to improve sphincter muscle relaxation to reduce food retention during swallowing. The patient lies in bed, lifts their head off the bed for a few seconds, and repeats 20 times.

- Techniques to enhance sensory awareness include changing food temperature, carbonated drinks, and acidic foods to improve oral-pharyngeal sensation, with an appropriate diet depending on the severity of the swallowing disorder.

* Level 1: Pureed diet (dysphagia puried).

* Level 2: Soft diet that does not include solid components (dysphagia mechanically altered).

* Level 3: Soft diet, including solid components (advanced dysphagia).

Level 4: Regular diet.

- Several techniques for holding your breath while swallowing.

- Coordinated measures to support swallowing rehabilitation include:

* Acupuncture.

* Medication (metoclopramide).

* Neuromuscular electrical stimulation (NMES).

* Pharyngeal electrical stimulation.

* Transcranial electrical stimulation (tDCS).

* Transcranial magnetic stimulation.