Within 24 hours of being diagnosed with a stroke at the hospital, a speech therapist will evaluate you and begin treatment. This is an important part of your recovery. Dysphagia, difficulty swallowing after stroke, can lead to complications and increased risk of death. In the first evaluation, the therapist will determine if it is safe to eat and drink. They will also decide what texture of food is safe to eat and what techniques are needed to prevent choking.
For some stroke patients, all food and drink is too high a risk for choking. In this case, a temporary or long-term feeding tube may be required until swallowing can be strengthened. A feeding tube is either placed in your nose and goes down to your stomach, or it is placed directly into the stomach by entering the upper abdomen. Feeding tubes prevent choking and help reduce aspiration (food going into your airway). A speech therapist and your doctor will determine if a feeding tube is necessary.
For patients that can have food and drink, a risk of choking still remains. You may have some changes made to your diet as well as learn different behaviors to help you eat. Stroke patients are safest when eating while most awake or attentive, with a caregiver, and while sitting up at a 90-degree angle. Food should be a soft, sometimes even blended, and bites should be small. Each bite needs to be chewed thoroughly. Before swallowing, drop your chin to your chest to allow more time to properly swallow. This is called a chin-tuck. Eating a soft-food or pureed-food diet are ways to reduce choking risk, as is using additives in beverages to thicken liquids.
Avoid very hot liquids and wide-mouthed cups to further prevent choking on liquids. Avoid finger-foods and food that is tough to chew or requires a lot of chewing. Also avoid foods that come in shapes that can be easily swallowed whole or aspirated, like grapes, peas or peanuts. Popcorn should also be avoided as it is very light and can easily go into your airway. While no action will completely remove the risk of choking, these strategies can help lower your risk.
Stroke often affects more than just swallowing, and many people will need help with eating. Caregivers can help prevent choking by ensuring proper eating techniques and awareness, feeding small bites of soft or pureed foods, and using utensils to slow the eating process. Straws help to slow and limit the amount of liquid that goes into the mouth when drinking. Using smaller spoons and forks provides smaller amounts of food for each bite. Finger food should be avoided as they can result in large bites of tough to swallow food. Caregivers should also allow full chewing and swallowing in between each bite and assist with proper chin-tuck technique, if required.
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