Stroke and dysphagia: an introduction
Stroke is one of the primary causes of dysphagia, but there are also other conditions that result in dysphagia. This article specifically focuses on the link between stroke and dysphagia, and explores what dysphagia is, why it is important to manage, and how it may impact daily living.
What is a stroke and what causes a stroke?
A stroke is a 'brain attack’ that occurs when the blood supply to part of the brain is suddenly cut off due to a clot (‘ischaemic stroke’) or leakage via a weakened blood vessel (‘haemorrhagic stroke’). A mini stroke (also known as a transient ischaemic attack (TIA) has many of the same signs and symptoms as a stroke, but the effects are only temporary.
How do you recognise a stroke?
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 swallowing difficulty, also known as 'dysphagia'. If you suspect that you or someone else is having a stroke, call for an ambulance immediately.
A comparison between a healthy swallow and one a dysphagia patient may experience.
What is dysphagia?
Normally, swallowing happens without much thought or effort, but it is actually a very complex process that needs the brain to co-ordinate some 30 pairs of different muscles1. If a stroke damages a part of the brain that helps control swallowing, it can affect a person’s ability to eat and drink safely. Difficulty with swallowing is called dysphagia.
What causes dysphagia?
Dysphagia occurs often as a result of stroke1,2. Other causes of dysphagia include the treatment effects of some forms of cancer, as well as neurological disorders such as Parkinson's disease, Alzheimer’s disease and multiple sclerosis. Also, older people often suffer from dysphagia due to weakening of the swallowing muscles. It may also be a side effect of using a breathing tube such as during intensive care within a hospital setting.
What are the signs of dysphagia?
There are several dysphagia symptoms that healthcare professionals can look out for. These include difficulty initiating swallowing, the feeling of food getting stuck in the throat, and coughing or choking while swallowing.
Why is it important to diagnose dysphagia?
- Undetected dysphagia can increase the risk of death after stroke through increased choking hazard and development of serious lung infection (aspiration pneumonia) if food and drinks enter the lungs rather than the stomach.
- Fear of choking or experiencing serious complications may make people with dysphagia feel anxious about eating and drinking, detracting from enjoying mealtimes and related social occasions.
- Dysphagia can also limit how often and how much is eaten and drank, limiting the intake of essential nutrients and liquids and leading to weight loss, malnutrition and dehydration, further inhibiting effective recovery from stroke and increasing the risk of additional complications, like pressure injuries, sarcopenia (muscle wasting) or even death.
If you feel you’re eating / drinking less or you lose weight go to HCP.
Why is nutritional status important and what happens if it is not addressed?
Patients are at risk of malnutrition.
Learn about disease-related malnutrition (DRM), who is at risk and how medical nutrition can provide the nutritional requirements to make a positive difference to health outcomes throughout life.
How is dysphagia managed after a stroke?
If dysphagia is diagnosed, a dietitian may be consulted for advice on which types of food and drinks are easiest and safest to consume.
The risk to inhale food in the lungs (“aspiration”) due to dysphagia can be managed by starting what’s known as a ‘texture-modified diet’, where foods and drinks are prepared to a consistency that’s easier and safer to swallow. Many may find such meals and drinks unappetizing, so medical specialists may recommend using thickening agents to improve the texture of food and drink, without affecting taste. Specially pre-thickened products might also offer a more convenient source of nutrition and could help to prevent malnutrition. In addition, there are groups like the Chef’s Council, 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!
What can you do besides a texture-modified diet?
Besides diet modification, a change in posture or manoeuvres to direct food away from the weak site can be used to manage dysphagia. Furthermore a therapist can help teach exercises and techniques to strengthen the mouth, tongue and throat. A relatively new treatment is neurostimulation to improve the functioning of brain areas which are necessary for proper swallowing.
How long does dysphagia last after stroke?
Around half of all cases display dysphagia in the weeks following a stroke. For most patients, symptoms resolve within 6 months. For other patients, whose stroke may have been more severe, dysphagia can be a life-long condition.
- González-Fernández M, et al. Curr Phys Med Rehabil Rep, 2013;1(3):187-96
- Wilmskoetter et al, Am J Speech Lang Pathol 2020;29:1030-1043