Basic Information about Swallowing Issues
Today I wanted to address swallowing issues that are common with individuals who have had a stroke or another neurological condition. I also want to discuss oral care and how it relates to overall health of patients with swallowing disorders. This is intended to be a basic overview for patients and their families and friends.
Difficulty swallowing can range from mild to profound with that being the inability to eat or drink by mouth resulting in the placement of a feeding tube. In the cases of stroke patients, often one side of the body is affected and that includes the lips, tongue, and throat muscles which can result in many issues with drinking, chewing, and swallowing,
Depending on the severity, residue can be present on the lips on the affected side of the mouth or there can also be pocketing inside the check which has to be cleared with tongue. It can even be so severe that the individual does not sense or feel that there is residue due to the affects of the stroke on sensation. In this case a verbal or visual cue can be helpful to remind them to clear it.
1-Make sure that anyone with issues swallowing is seated at 90 degrees and remains upright at 90 degrees following the meal to reduce safety issues with choking/reflux.
2-Sauces/gravy can be very helpful with some swallowing disorders to reduce the risk of choking. Alternation of liquids and solids with 2 bites and then one sip can also be beneficial.
3-Taking small bites and sips is very important and may require your assist to cut up items into bite size pieces.
4- Talking during meals is very difficult and can be dangerous for a person with difficulty swallowing. Keep distractions to a minimum until finished eating.
5- As always check with your SLP in order to determine the best precautions/diet recommendations for your loved one.
In the case of a more severe swallowing disorder, there can be coughing and choking with meals and often individuals require ground meat, thickened liquids and/or pureed food items. When a patient begins to demonstrate swallowing disorders or during the assessment in the hospital following a stroke, a Speech Language Pathology Evaluation should be ordered by the physician. Swallowing Instrumentation is considered best practice to determine the presence and severity level of dysphagia (difficulty swallowing) and identify underlying impairments. Without diagnostic information in the form of a FEES (Flexible Endoscopic Evaluation of Swallowing) or MBS/VFS Modified Barium Swallow Study/ Video Floroscopic Swallow Study it is impossible to tell exactly what the problem is and what to do about it. In the same way you would require a X-ray prior to determining if a bone was broken, SLPs cannot be expected to “diagnose” swallowing impairments without FEES or MBS/VFSS.
Honestly, it is shocking how often oral care is neglected. Whenever my mother was in the hospital, no one would have brushed her teeth as she was completely incapacitated and unable to do her normal oral care routine herself. She has always been very regimented about flossing and brushing after meals. My sister and I brushed and attempted to floss as best we could every morning and night. It would not have happened if we had not done it ourselves. Unfortunately, oral care is not readily provided in many facilities. Please know I am in no way speaking negatively about hospitals, nurses or CNA’s. I feel that it is lack of education and resources. Often, employees are short staffed and maybe even unaware of the potential health issues associated with lack of oral care. One of the reasons for writing this blog in general is to help to provide information, education and resources that are needed when our loved ones have medical issues arise.
1-Do not rely on lemon glycerin swabs or toothettes swirled in mouthwash for oral care. Lemon Glycerine Swabs are NOT effective at soothing dry mouth and instead create increased acid and rebound dryness.
2-Use a toothbrush, even if the patient does not have teeth to clean the bacteria from the gums, tongue and surfaces of the mouth.
3-Rinse mouth out and spit into basin or sink. If the patient cannot spit, use a suction toothbrush.
4-Floss between teeth at least once per day.
(MedSLP Collective, with contributions from Hillary Cooper, M.A CCC-SLP,)
The importance of oral care in patient’s with swallowing issues cannot be overemphasized.