If you or a loved one has suffered a stroke, you are probably already familiar with signs such as weakness or numbness in an arm, leg, or even the face. Just as a stroke can affect these large muscles, it can also affect the muscles and nerves that control our ability to swallow. Swallowing seems simple, but is actually a coordinated series of events that protects you from choking, which can lead to serious injury or death.
Normal swallowing includes chewing food using muscles of the face, jaw and tongue. You also have to feel the food in your mouth so your tongue can keep you from choking, and move the food around to ensure the food is well-chewed. Next, sensing the food’s location, you use your face, jaw and tongue muscles to push the food to the back of your throat. Your muscles work together to produce a wave backwards. This pushes the food to the back of your mouth. Once your throat feels the food, your epiglottis (tissue that covers your windpipe) closes to prevent food going into your airway. Then your esophagus begins another set of wave-like contractions to push food down to your stomach.
With a stroke, part of your brain is scarred from lack of blood supply. Any actions normally managed by that part of the brain are temporarily or permanently lost. If stroke results in the loss of sensation or muscle function of swallowing, dysphagia (difficulty swallowing) and choking occur. A common sign of stroke is a droopy mouth or slurred speech. Patients with these symptoms have lost the sensation and muscle function to control their mouth and will also show signs of choking. This can interfere with the swallowing process, from putting the bite into the mouth through pushing the food to the throat. Any abnormal coordination in these functions can results in difficulty swallowing or choking.
You should immediately contact your doctor if you have problems swallowing or choking. Signs include abnormal sensation in the throat, coughing, drooling, clearing your throat while eating, and abnormal head and neck movements to assist with swallowing. If possible, avoid food and drink until you see a doctor or other health professional. A speech therapist can test your ability to swallow and detect any choking.
A speech therapist can test swallowing with all qualities of food, from liquid to chicken. Every patient can have a different level of difficulty. The speech therapist can tell you which foods to avoid. Most patients require a special diet until strength and sensation are restored. This diet might include soft and blended foods and honey-thickened liquids, as they are easier to swallow and don’t lodge in your throat if you do choke.
If you have difficulty swallowing after a stroke, it’s important to work with your speech therapist to gain as much function back as possible. The more aggressive the therapy, the more likely you will get function back. You should also avoid foods that are common choking hazards, such as hot dogs and grapes. Until a doctor tells you to do differently, you will eat soft or pureed foods, and sit up at a 90-degree angle while taking slow, small bites.
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