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.

Stroke Lingo: Part 2


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.
[https://www.neofect.com/us/blog/stroke-lingo-part-1]

References:

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

American Stroke Association:
https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/difficulty-swallowing-after-stroke--dysphagia

Stroke Foundation:
https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Swallowing-problems-after-stroke-fact-sheet

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.