Dysphagia / Swallowing disorder
Brain damage can cause people to have temporary or structural problems swallowing food, drink, saliva or medication and getting it into the stomach. This is also called dysphagia.
The most serious form of a swallowing disorder may occur after brain stem damage. Swallowing disorders also occur with neurodegenerative conditions such as MS, Parkinson's, Huntington's, dementia and also after a stroke, brain tumor, traumatic brain injury and many other types of brain injury.
Complex cooperation of brain and muscles
It takes six cranial nerves and 32 muscles to swallow properly. This requires a good cooperation and that often falters after a brain injury.
Danger
- choking, suffocation
- respiratory infections, pneumonia (aspiration pneumonia)
- malnutrition
- dehydration
- increased risk of pressure sores (decubitus) due to poor nutritional status
- fatigue from eating
- fear of swallowing
- reduced self-esteem
- increased risk of death
There is a high chance that a person will choke repeatedly and get respiratory infections if food or drink ends up in the lungs or in the airways. Pneumonia as a complication can be fatal.
A person can also lose weight unintentionally and become malnourished or dehydrated due to swallowing problems.
The following symptoms may indicate a swallowing disorder
- A dry mouth
- Chewing slowly
- Playing with food in the mouth
- Food that remains in the cheek pouch or against the palate
- Saliva or food that runs out of the mouth
- Clearing the throat after swallowing
- The feeling that food or medication remains after swallowing (globus sensation)
- Swallowing is painful
- Difficulty starting to swallow
- The feeling that food gets stuck in the throat or behind the breastbone
- Choking frequently
- Coughing or hacking during, before or after eating or drinking
- Inflammation of the lungs or airways due to choking
- A bubbling, gurgling, rattling voice or bubbling breathing
- Weight loss without wanting to lose weight or signs of dehydration
- Heartburn, heartburn, belching or throwing up food
- Having to sneeze while eating or drinking. Sometimes food or drink leaks out through the nose
- A runny nose while eating or drinking
- Having to swallow repeatedly to ‘get the food or drink down’.
- Tired after eating or drinking
Examinations
- A nurse or a speech therapist can perform a water swallow test.
- A speech therapist can examine people with swallowing disorders to see at which stage of swallowing it goes wrong. Oral inspection with a cotton swab, tongue depressor and light.
- A speech therapist can perform a FEES (Flexible Endoscopic Evaluation of Swallowing) examination with a viewing tube in the nose. During this examination, the patient has to eat or drink different things with different thicknesses and of different substances.
- An ENT (Ear Nose Throat)-specialist can look into the throat painlessly with a flexible camera tube and examines the pharynx and larynx. This examination is called a laryngoscopy.
- An ENT-specialist can also perform the FEES (Flexible Endoscopic Evaluation of Swallowing) examination with a camera tube through the nose.
- A gastroenterologist can examine the esophagus with a camera tube. This examination is called an esophagoscopy. The throat is numbed.
- A swallowing photo or swallowing video can be taken at the X-ray department. This can show that food or drink gets stuck in the throat cavity or that there is an overflow into the trachea.
- A VFES (= videofluoroscopic evaluation of swallowing) examination can be performed at the X-ray department. For this the patient has to drink a contrast agent.
Help
- The speech therapist can provide swallowing rehabilitation. Swallowing techniques or compensation techniques are taught. The diet can also be adjusted.
- Electrical stimulation of the pharynx/esophageal head/pharynx seems to be a promising new approach for the treatment of swallowing difficulties/dysphagia. The electrical stimulation of the pharynx stimulates the nerves that control the swallowing function.
- In case swallowing is really no longer possible, tube feeding can be a way to still get food and drink. This can be a nasogastric tube through the nose or a PEG tube (= Percutaneous Endoscopic Gastrostomy Tube). This tube is surgically inserted into the stomach through the abdominal wall. Sometimes tube feeding is given in addition to the normal diet.
- An occupational therapist can provide advice on adapted materials such as cups and plates with raised edges or spoons with adapted handles. When using a spout cup, it is important to be able to see how much is left in it.
- A dietician can advise on nutritional needs and nutritional consistency.
- A physiotherapist can provide breathing exercises and muscle support exercises.
Tips
- Ice-cold drinks or food are easy to swallow. Although eating too hot or too cold can be very unpleasant.
- Thicken the drink if necessary.
- Puree food, ground food or spoonable food such as custard and porridge.
- Smooth food is easier to swallow.
- Eat calmly with small bites.
- Do not distract the person with a swallowing disorder while eating or drinking.
- Have the person with the swallowing disorder eat sitting upright as much as possible.
- Support the paralysed side.
- Offer the food to the healthy side, not to the affected/paralysed side.
- If necessary, ensure that there is a suitable denture.
- Eat several small meals a day.
- Do not take another bite until your mouth is empty.
- Do not rinse your mouth with a drink after solid food.
- Stop eating and drinking immediately if you choke - try to cough up the food, do not lie back under any circumstances.
- Remain upright for at least fifteen minutes after eating.
- Seeds, membranes, grains increase the risk of choking, as does crumbly food such as a hard-boiled egg or cake.
- Check that your mouth is empty after eating.
- Maintain good oral hygiene, brush your teeth, brush your tongue, use mouthwash (beware of choking!). Poor oral hygiene can also cause pneumonia if food remains end up in the windpipe. Poor oral hygiene can also cause other infections. Maintain oral hygiene before and after eating. Beforehand, so that you can inspect your mouth properly to see if there are any food remains.
- Keep your mouth moist with lip balm.
- As a caregiver, learn the "Heimlich maneuver" to help during choking. If that doesn't help, call an emergency number.
More information:
https://braininjurycanada.ca/en/living-brain-injury/dysphagia/
https://www.mayoclinic.org/first-aid/first-aid-choking/basics/art-20056637
https://pmc.ncbi.nlm.nih.gov/articles/PMC6657766/
https://www.health.qld.gov.au/__data/assets/pdf_file/0029/674039/dysphagia_abi_fsw.pdf
https://www.hopkinsmedicine.org/health/conditions-and-diseases/swallowing-disorders