Stroke: Too Much to Swallow

It seems so easy. We've been doing it throughout our lifetime without thinking about it. We take a bite of food, chew it, and swallow, while simultaneously listening to table conversation or reading the paper or thinking about something other than what we are doing.

After a stroke this type of multitasking may be impossible without choking or, in worse case, food aspiration into our airway.

The brain controls our autonomic nervous system; swallowing, sneezing, and coughing, just to name a few automatic responses. Think of this system as our fail safe system. We breathe into our lungs and air is exchanged. We ingest food and liquid and it passes through our esophagus into the stomach. But after a stroke this fail safe system may be compromised by damage to areas of the brain that control our autonomic system.

The survivor may not even be aware of the compromise to the airway and may not be able to cough, therefore causing a "silent aspiration." A serious complication to stroke recovery can result in pneumonia or inadequate nutrition.

This swallowing problem (referred to as dysphagia) may occur immediately after a stroke and self-correct within a short time or continue to occur.

The very first test for this post-stroke difficulty is performed at the hospital bedside by a speech-language pathologist. A plan for each survivors swallowing problem is individually evaluated and addressed and a Treatment Plan is implemented by the Stroke Team.

Although each plan is designed for the individual depending on their particular swallowing difficulty, here are some techniques that may be included in such a treatment plan. Liquids may have to be thickened to allow for slow swallowing of thicker substances. Take smaller bites and chew thoroughly before swallowing. Some foods may be too difficult to chew and a specific diet may be necessary.  Sometimes, tucking your chin to your chest or turning the head to one side when swallowing may be helpful. Make sure your mouth is completely empty of food before taking another bite. It is very important to provide a meal time that is free of interference like television or conversation.

Even 16-years post-stroke, I infrequently have swallowing difficulties. Now, my body will automatically react by choking, sneezing, or both.  But I need to know how to handle the situation. I STOP. I close my eyes to improve concentration, and breathe through my nose. If the airway is constricted I empty my mouth and cough or sneeze until it is clear. If it is not restricted I relax, slow down, and remind myself that, for me, eating is a re-learned duty to my body with consecutive steps that must be followed.   

After a stroke, we are continuously working on gaining skills that have been taken for granted our entire life. Eating - consuming adequate nutrition - is one of the most important.

Related posts:

Stroke Heroes and Their Pets

A Lifetime of Stress Could Be a Precursor to Stroke