Care Guides for Caregivers

Swallowing after Stroke (Dysphagia)

Post on 06/07/16

Stroke survivors may present with swallowing problems, also known as dysphagia.

When the sensation, strength, and / or coordination of muscles involved in swallowing are affected due to the brain damage, the patient’s ability to swallow safely may be affected.

Here are some common problems that may occur:

In the mouth

The patient may have difficulty chewing and controlling food and liquid. Thin liquids, such as water, coffee and clear soup, are the most difficult for a person to drink as good muscle control is needed when swallowing. In addition, patients may pocket food in the mouth because he is unaware of its presence. Drooling may also occur.

In the throat

When the muscles of the throat are weak or when sensation is reduced, the patient may not be able to protect his airway. As a result, food or liquid may also remain in the throat after a swallow, and the person may not be aware of this remainder.

At the junction of the throat and food pipe

Food and liquid may have difficulty passing from the throat into the food pipe.

Signs of swallowing problems

A patient with a swallowing problem will typically show one or more of the following signs:

  • Coughing and / or choking
  • Throat clearing after swallowing
  • Wet and gurgly sound in the throat after eating or drinking
  • Increased drooling or saliva
  • Increased effort while trying to swallow

Possible consequences of swallowing problems

Aspiration pneumonia

Aspiration occurs when the food or liquid passes into the lungs as a result of entering the airway instead of the food pipe. A person who aspirates is at risk of pneumonia.

Weight loss and / or malnutrition

This may occur if the person loses appetite due to tiredness / fatigue or difficulty swallowing / eating.

Dehydration

Dehydration may occur when the person is unable to drink enough liquids.

How speech therapy can help

  • Identifying patients with swallowing problems
  • Identifying the problem areas within swallowing
  • Advising the patients on tests that need to be done to investigate the cause of swallowing problems
  • Educating the patient and carers on the causes and consequences of swallowing problems
  • Educating the patient and carets on ways to improve swallowing •
  • Performing swallowing therapy and monitoring the progress

Helping patients with swallowing problems

As the patient recovers, he may start oral feeding again. Initially. modified food or liquids may be required. The following are some examples for each category of food and liquids that may be recommended by the Speech Therapist.

Blended or pureed diet

Blended diet has a thick, smooth consistency. It may be thick and should be moist rather than sticky when eaten. In preparing the blended diet, it is best to blend each food separately, adding water to moisten if needed. However if the food is too thin, add thickening agent.

Some examples of foods that may be put through the blender:

  • Porridge
  • De-boned soft meat in sauce or gravy
  • Pasta in sauce
  • Mashed potato in gravy
  • Carrots, broccoli or cauliflower and butter
  • Skinned stewed fruit
  • Bananas

Foods to be avoided when the patient is on blended diet are:

  • Dry food
  • Wholegrain bread
  • Fish with bones
  • Tough, stringy or dry meat
  • Fried rice
  • Dishes containing nuts or seeds
  • Sweets
  • Soft diet

Soft diet has more texture than blended diet. It may contain food pieces that are easily mashed into bite-size pieces. Soft food may be served or coated with thick gravy or sauce.

Examples of soft diet include:

  • Porridge
  • Flaked fish
  • Minced meat in gravy
  • Well-cooked pasta
  • Scrambled eggs
  • Baked / mashed potato with soft filling e.g. egg mayonnaise
  • Well-cooked cauliflower, broccoli
  • Sponge cakes with milk / cream
  • Liquids

Liquids may need to be thickened using a thickening agent. This will reduce the chances of it entering the lungs instead of the stomach.

The speech therapist will recommend liquids thickened to the specific consistency appropriate for the patient.

This may include:

  • Pudding consistency (yoghurt like)
  • Honey consistency (milkshake like)
  • Nectar consistency (fruit juice like)

The above-recommended foods are only a guide and some patients may find it easier to cope with certain consistencies that other patients may find difficult.

Feeding precautions

Observe these precautions when caring for someone with dysphagia:

    • Bed head up at 90 degrees during oral feeding and beyond 45 degrees during NG or PEG tube feeding. Remain upright for 30 minutes afterwards to prevent reflux
    • Head supported slightly forward during meals
    • Make sure patient maintains a good level of alertness during feeding
    • Feed only recommended consistencies of food and liquids
    • Make sure medications are of appropriate consistency e.g. crushed, thickened
    • Follow recommended safe swallowing methods at all times e.g. multiple swallows, chin tuck, effortful swallows
    • Feed slowly; supervise impulsive patients
    • Reduce distractions during feeding
    • Stop feeding if you observe:
      • Coughing
      • Wet / gurgly or hoarse voice
      • Shortness of breath
      • Patient becoming less alert
      • Distress
    • Carry out oral hygiene three times daily for all patients on NG / PEG tubes
    • Patients are only to be fed by a speech or therapist or nurse until their caregivers are properly trained

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