Let’s Talk About Post-Stroke Dysphagia
Dysphagia is a medical term for difficulty in swallowing. It’s one of the common complications after stroke, affecting nearly two-thirds of survivors of stroke during the early part of recovery. While many improve within a few weeks, others experience longer-term challenges that can affect safety, nutrition, and quality of life.
How Does Swallowing Work?
Swallowing may seem like a simple and natural function, but it’s actually a complex process involving the brain, muscles and nerves. Swallowing is how the food is moved from your mouth to your stomach.
Swallowing has three stages and a stroke may affect one or more of these phases due to muscle weakness, poor coordination, or delayed reflexes.
Common Signs of Dysphagia Include:
- Pain or discomfort while swallowing
- Not being able to swallow (food or pills remaining in the mouth or stuck in the throat)
- Drooling
- Coughing or throat clearing during or after eating or drinking
- “Gurgly” or wet-sounding voice after swallowing
- Difficulty coordinating breathing and swallowing
- Eating slower than normal or avoiding eating/drinking
- Feeling that food or drink has “gone down the wrong way”
- Weight loss, malnutrition or dehydration
- Recurrent chest infections or pneumonia
Evaluation and Diagnosis
Early screening is essential in improving outcomes. Diagnosis involves screening, clinical evaluation and instrumental evaluation. Initial screening, such as interview questions or observation of difficulty, will lead to further assessment of swallowing function.
If left untreated, dysphagia can result in
- Social withdrawal
- Aspiration, often referred to as something “going down the wrong pipe” (when something other than air gets into your airway and causes coughing, chocking or infection)
- Dehydration
- Malnutrition
- Disability or challenges with recovery
- Longer hospital stay
- Higher health care costs
- Even death
Treatment Options
There are helpful treatments for swallowing problems after a stroke. These include both ways to react quickly when problems happen and exercises to make swallowing safer over time. These treatments can help prevent food or drink from going into the lungs, which can cause serious illness.
Patient, family, caregiver education: Complications related to dysphagia, treatment options and tips such as oral hygiene and care, upright positioning for orally fed patients and oral sensory stimulation.
Swallowing maneuvers or compensatory strategies: Techniques such as chin tuck or head up, can help improve how well the muscles work together to make swallowing safer and easier.
Diet modifications: Changing food textures and thickening liquids.
Oral motor strengthening exercises: Exercises that can help improve swallowing function and strengthen muscles. This may include tongue exercises, lip closure exercises, chewing exercises, jaw exercises and others.
Neuromuscular Electrical Stimulation (NMES): This therapy uses gentle electrical currents to stimulate muscles involved in swallowing, helping to retrain and strengthen them.
Recovery and Support
While dysphagia can be frightening, many regain safe swallowing abilities with early intervention and support. The SLP and a registered dietitian will be important members of your health care team to support you in this post-stroke condition. In addition, you’ll need to:
- Follow up regularly with your care team
- Practice prescribed exercises
- Don’t eat or drink until you’ve been cleared by a specialist
- Engage in frequent oral care
How can I learn more?
- Call 1-888-4-STROKE (1-888-478-7653) or visit stroke.org to learn more about stroke or find local support groups.
- Sign up for our monthly Stroke Connection e-news for stroke survivors and caregivers at StrokeConnection.org.
- Connect with others who have also had an experience with stroke by joining our Support Network at stroke.org/SupportNetwork.
Do you have questions for your doctor or nurse?
Take a few minutes to write down your questions for the next time you see your health care professional. For example:
What signs of dysphagia should I watch for at home?
What diet changes might help?
What can I do to improve my swallowing?
We have many other fact sheets to help you make healthier choices, manage your condition or care for a loved one.
Visit stroke.org/LetsTalkAboutStroke to learn more
Nationally supported by Encompass Health.
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