To continue our discussion about tricky stroke-related terms, let’s talk about some words that relate to swallowing disorders that can occur after a stroke. The words to describe these disorders are often big, complicated, and intimidating. Let’s break them down to be more manageable!
Post-Stroke Swallowing Terms:
Dysphagia: the medical term to describe difficulty swallowing.
Swallowing is actually a pretty complex functional skill that involves the brain, certain nerves and muscles, and a working esophagus. Once food or liquid enters the mouth, the body goes through 4 stages to take the substance all the way to the stomach, while also protecting all other organs that are not involved in swallowing. After a stroke, the centers of the brain that control all of these stages may be impacted, making swallowing difficult or even impossible.
A person with dysphagia following a stroke may have difficulty with one or multiple parts of the swallowing stages, and may experience a range of symptoms. Some may have impaired feeling along the swallowing passageways, making it difficult for the body to reflexively move the food along. Some may have weak muscles that don’t allow for a forceful or efficient enough push through the different swallowing passageways. In all cases, it is best for a qualified professional to screen for the range of swallowing difficulty so that the patient can immediately use safety precautions to prevent complications, and learn strategies to get better at swallowing.
Aspiration: a complication related to dysphagia that means food or liquid has managed to escape the usual swallowing passageway and has entered the breathing passageway instead, making its way to the lungs instead of to the stomach.
In some cases, aspiration can lead to aspiration pneumonia, which is a certain kind of pneumonia that happens when bacteria from food caught in the lungs causes a life-threatening chest infection. It is extremely important to work with professionals to manage dysphagia, maximize a person’s safety, and prevent aspiration and aspiration pneumonia.
Modified Barium Swallow Study (MBS): a special type of X-ray that is looked at in real-time to analyze 3 phases of swallowing: oral (mouth), pharyngeal (throat), and upper esophagus.
A patient will swallow a special testing liquid (barium), then fluoroscopy is used to show a continuous, almost movie-like, image on the monitor. Typically, a speech therapist along with a radiology clinician will be present during the study to closely observe what happens to the barium as it passes through these phases of swallowing. This helps to determine the level of severity of dysphagia, and helps the speech therapist make a plan for rehabilitation and safety while swallowing food and liquids.
NPO: an order placed by a physician in the patient’s medical chart that lets everyone know this person is not currently allowed to eat or drink anything by mouth.
The NPO comes from the Latin “nil per os,” which means “nothing by mouth.” In the case of a stroke, this is because the person may not have the ability to safely swallow yet (or may be undergoing screenings to figure this out), and is at a very high risk for aspirating food and liquid. Usually there will be signs up in the room so that staff and visitors know not to give the person any food or drinks, since it could be a serious danger. If practitioners think the patient may need to remain NPO for a prolonged time, they will set up a special feeding system through a tube in the nose or abdomen that sends liquid nutrition straight to where it needs to go, avoiding contact with the lungs. The patient’s speech therapist will help to assess the person’s progress with safe swallowing and will be in contact with the doctor as soon as it is safe to start eating and drinking again.
Modified diets and thickened liquids: special adaptations to food and drink that allow a person to swallow more safely, based on speech therapy recommendations.
When a person has dysphagia after a stroke, a speech therapist will likely be very involved in rehabilitation strategies to improve safety and function related to swallowing. A big component of this rehab may include exercises to strengthen and improve coordination of swallowing muscles. Another big component may be using adaptive strategies to make swallowing safer and easier. Foods may need to be mechanical soft (chopped up) or pureed (like mashed potato-consistency), and liquids may need thickeners added (“honey thick” or “nectar thick”), all in order to help the swallow process along. The speech therapist may also make recommendations for special strategies to use while the person eats and drinks, like having supervision, taking small bites/sips, and sitting upright.
Each person is different and may experience difficulties related to dysphagia in different ways, so the patient’s therapists play a vital role in establishing and monitoring exercises and strategies specific to that patient’s needs. Safety and resuming maximum function and quality of life surrounding eating and drinking are prioritized. If you are a loved one trying your best to support a person experiencing dysphagia, your patience and understanding with specific adaptations are very valuable! Helping to follow the therapists' recommendations for adding thickener to liquids, ensuring proper positioning for meals, and modeling a slower pace while eating are all great ideas to get started.
To read part 1, click here.
Gonzalez-Fernandez, M, et al. Dysphagia after stroke: An overview. Current Physical Medicine and Rehabilitation Reports. 2013; 1(3): 187-196. 10.1007/s40141-013-0017-y
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