Stroke and dysphagia: an introduction

A stroke is a ’brain attack’. It happens when the blood supply to part of the brain is suddenly cut off due to a blood clot (‘ischemic stroke’) or leakage via a weakened blood vessel (‘hemorrhagic stroke’). A mini stroke has many of the same signs and symptoms as a stroke, but the effects are only temporary. Signs of a stroke (stroke symptoms) include sudden weakness or numbness in the face, arm or leg, and sudden confusion and trouble speaking. Common problems occurring as a result of stroke include poor movement and balance, as well as a swallowing difficulty known as 'dysphagia'.

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A comparison between a healthy swallow and one a dysphagia patient may experience.

What is dysphagia? A definition of dysphagia

Normally, swallowing happens without much thought or effort, but actually it’s a very complex process that needs the brain to co-ordinate some 30 pairs of different muscles.1 If a stroke damages a part of the brain that helps control swallowing, it can affect a person’s ability to chew and swallow safely. This is known as dysphagia1,2. Oropharyngeal dysphagia is where a patient has trouble moving food from the mouth to the esophagus, whereas esophageal dysphagia affects the ability to move food down the esophagus into the stomach1.

What causes dysphagia?

Dysphagia occurs most often as a result of stroke1,2. Other causes of dysphagia include the treatment of some forms of cancer, as well as neurological disorders such as Parkinson's disease, Alzheimer’s disease and multiple sclerosis. It may also be a side effect of using a breathing tube such as during intensive care within a hospital setting.

How long does dysphagia last after stroke?

Around half of all stroke patients experience swallowing difficulties3. For most patients with dysphagia after stroke, symptoms may resolve after 6 months; for other patients, whose stroke may have been more severe, dysphagia can be a life-long condition4,5.

Why is it important to screen for dysphagia?

Dysphagia can not only be an uncomfortable and sometimes painful condition, but also a potentially dangerous one. It can increase the risk of death in stroke patients, with patients at risk of choking or developing serious lung problems such as aspiration pneumonia if food and drinks enter the lungs rather than the stomach6. Fear of choking and these serious complications make many people with dysphagia feel anxious about eating and drinking. This can often stop people enjoying mealtimes and related social occasions.

Mealtimes: more than just nutrition First and foremost, eating and drinking are necessary to give your body the right nutrients for good health. But mealtimes are also important for your quality of life. Ideally, mealtimes should be positive, relaxed, enjoyable occasions.

When mealtimes are less enjoyable, they may start to limit how often and how much is eaten. Over time, this can lead to weight loss, malnutrition and dehydration7-12 – all of which make it harder for the body to recover after a stroke, and could lead to secondary health issues such as sarcopenia (muscle wasting) and pressure injuries13,14. For these reasons it is very important that dysphagia is identified early and managed appropriately1.

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Signs of dysphagia

There are several dysphagia symptoms that healthcare professionals can look out for. These include trouble chewing, food sticking in the throat and coughing or choking while swallowing. If dysphagia is diagnosed, patients may be referred to a speech and language therapist to teach them exercises and techniques to strengthen the mouth, tongue and throat. Patients might also see a dietician for advice on which types of food and drinks are easiest and safest to consume.

How is dysphagia managed?

Dysphagia treatment can be managed by starting what’s known as a ‘texture-modified diet’, where foods are blended to a consistency that’s easier and safer to swallow. Many patients may find such meals and drinks unappetizing, so medical specialists may recommend using thickening powders to improve the texture of food and drink without affecting taste. Specially pre-thickened products might also offer a convenient source of nutrition. In addition, there are groups working hard to create recipes specific to the needs of dysphagia patients that are not only safe and nutritious, but appetizing and visually appealing too!

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Dysphagia following stroke and its impact on eating and drinking

Swallowing difficulties such as dysphagia can lead to increased anxiety at mealtimes. The risk of accidently inhaling drinks or food can lead to loss of enjoyment when eating or drinking. Some patients will reduce their fluid and food intake out of worry; the levels of malnutrition and dehydration in dysphagia patients are high and can negatively impact the recovery process[15-20]. An effective and widely used way of managing dysphagia is to change the consistency and texture of food and drinks.

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The Chefs Council: bringing haute cuisine to dysphagia cooking

Texture-modified diets are safer to eat but can be unappetizing as food needs to be blended to a specific consistency before it can be consumed. This is where the Chefs Council step in. They are a team of world-class chefs, stroke and dysphagia experts as well as patients and carers who are working hard to improve the quality of life of people with dysphagia. Together they created the Dysphagia Act, which is founded on three key principles: that dysphagia foods and drinks should not only be safe and nutritious but pleasurable too.

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