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Difficulty Swallowing

Some individuals have difficulty swallowing after stroke. This is also called dysphagia (dis-FAY-ja).

Stroke may affect the person's ability to swallow in the following ways:
-Muscles in the mouth, throat, tongue or lips may become weak.
-The mouth may feel numb or tingly.
-Swallow may become slow.
-Gag or cough reflex may be weakened or no longer present.

The following problems can result from having difficulty swallowing:

Woman drinking tea-Poor nutrition.
-Poor fluid intake, which can lead to dehydration.
-Coughing and choking.
-Blocked airway or trouble breathing.
-Food may get into the lungs. This is called aspiration and may cause a lung infection called pneumonia.

A nurse, doctor or speech therapist examines individuals with stroke for swallowing difficulties prior to discharge from a hospital or rehabilitation unit. If the individual you are caring for begins to have difficulty swallowing after returning home, notify your health care provider as soon as possible.

If the individual with stroke is diagnosed with difficulty swallowing, he or she will be given exercises to help strengthen the muscles that are used for eating. A special diet may be ordered to prevent choking or aspiration - a thickening agent may need to be added to all liquids to prevent choking.

As a caregiver of an individual with stroke, encourage the following behaviors to help prevent complications for those who have difficulty swallowing:

-Do not eat in bed. -Turn the head down, tuck the chin to the chest, and bend the body forward when swallowing. This provides greater swallowing ease and helps prevent food from entering the airway.
-Sit up straight when eating. -Perform double swallow of all food [swallow twice] before taking the next bite or drink.
-Follow the diet ordered by your health care provider. -Take a sip of liquid to wash down food sticking in the throat; a sip of liquid after each bite of food may be helpful.
-Only take one food or liquid at a time. -Eat slowly; allow at least thirty minutes to complete a meal.
-Take 1/2 to 1 teaspoon of food at a time. -Eat in a quiet area to avoid distractions
-Place food on side of mouth that does not have weakness, numbness, or tingling -Do not talk while eating.
-Sip liquids and use a wide-mouth drinking cup to determine progress of liquids into the mouth. -Perform tongue sweep of mouth to self-check for food.
-Chew food completely before swallowing. -Brush teeth and rinse mouth after eating, this will prevent choking on food particles that may be in the mouth.
-Remain in upright position for 30 minutes after eating.  


Additional Information:

The following are some websites to provide you with more information about difficulty swallowing:

Dysphagia Diet

Swallowing Difficulty


References:

American Heart Association. (2010). Difficulty swallowing after stroke. Retrieved from http://www.strokeassociation.org

Black, M. & Hawks, J. (2008). Medical-surgical nursing: Clinical management for positive outcomes (8th ed.). Philadelphia, PA: Saunders.

Dysphagia. (2011). Retrieved from http://emedicine.medscape.com/article/324096-overview

Geyer, J.D. & Gomez, C.R. (2009). Stroke: A practical approach. Philadelphia, PA: Lippincott.

Stein, J. (2009). Stroke recovery and rehabilitation. New York, NY: Demos Medical Publishing

Developed in 2001 by Gerri Rupp, MSN, RN, CNP at the University of Toledo for Caring~Web©.

Revised 2010, 2012



Last Updated: 6/17/14