Stroke rehabilitation on swallowing difficulties

Swallowing difficulty is a common consequence of stroke. Almost half of people who have a stroke will experience swallowing difficulties. This factsheet explains how having a stroke affects swallowing and the treatments that are available to help you. 

How does stroke affect my swallowing?

Swallowing is a complex task which requires your brain to coordinate different muscles in your mouth and throat. A stroke can affect the way you move food around in your mouth and your ability to swallow. This is known as dysphagia.

What are the complications of dysphagia?

During normal swallowing, food enters the food pipe and into the stomach.

If you cannot swallow normally, food and drinks may enter your airway and lungs instead. This is called aspiration. Some signs of aspiration include coughing and choking. However, for some people, aspiration may not have any symptoms or signs. This is called silent aspiration. Both aspiration and silent aspiration can lead to lung infection, which can be very serious. In addition, people with dysphagia are also at risk of dehydration and malnutrition.

Therefore, it is important that a trained speech therapist assesses your swallowing function, especially if you show these signs during or after eating and drinking:

• Coughing
• Throat clearing
• Choking
• Feeling of food or water getting stuck in your throat
• A wet-sounding voice
• Difficulty breathing

What treatment is available?

If you have dysphagia, you should be referred to a speech therapist. Sometimes, you may also be referred to a dietitian. They each have a role in managing dysphagia and its consequences.

Speech Therapist

A speech therapist assesses your swallowing function and advises you on the following treatment strategies, where appropriate:

	Swallowing rehabilitation exercises These exercises focus on training the affected muscles to improve your swallowing function and minimise or prevent complications.
	Modified diet and drinks consistency To make swallowing easier and safer, you may have to make changes to  your diet and drinks. This may include thickening your drinks or altering the texture of your food by mincing, mashing or pureeing it.
	Enteral (Tube) feeding If swallowing is unsafe for you, you may require alternative methods of feeding. Enteral feeding, or the use of a feeding tube, may be recommended for you as a means of safely delivering hydration, nutrition and medication directly into your stomach. Examples of enteral feeding include the use of a nasogastric tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube. Your doctor and speech therapist will discuss these options with you to identify which is most suitable for you.

Dietitian 

As dysphagia can make it difficult to eat and drink, it can result in dehydration, weight loss and malnutrition. A dietitian can ensure that you are getting enough nutrition.

A dietitian can advise you on:

• Techniques and instructions to prepare nutritious and healthy meals in the consistencies that have been suggested by the speech therapist
• Ways to supplement the nutrients required by your body
• Developing a meal plan or a feeding regime for those on enteral feeding

How can I recover?

Research has shown that dysphagia may improve within the first few weeks of the stroke. However, depending on the severity and the type of the stroke, a small number of stroke survivors will experience long-term difficulties. 

If you are still experiencing dysphagia upon discharge, please continue to follow-up with your speech therapist. The speech therapist will work together with you and your caregivers to plan a home programme for your rehabilitation and ensure that you are eating and drinking at home in a safe manner.

If you are going home with a feeding tube, you or your caregiver will be trained to manage tube feeding at home. There are also community services available that can help you with the care of the feeding tube if needed.

Some helpful tips

• Follow the advice from your speech therapist.
• Take small mouthfuls when eating and drinking.
• Chew and swallow every mouthful slowly and carefully.
• Sit up straight during mealtimes and for at least 30 minutes after meals.
• Clear all food in your mouth before taking another bite.
• Stay focused when you are eating.
• Remove environmental distractions e.g. switch off the TV during mealtimes.
• Take small frequent meals throughout the day if three standard meals are too tiring for you.
• Maintain good oral hygiene. Brush your teeth three times daily. If you wear dentures, ensure that they are cleaned regularly after every meal.

Article available in Chinese, Malay and Tamil. 

For more information on how to better manage your stroke recovery, visit Stroke E-Resources. 

StrokeHub Video: 

Swallowing Difficulties (Extended Version)

Swallowing Difficulties