Brain injuries can sometimes result in difficulty swallowing (known as dysphagia). The signals from the brain that tell the muscles of the mouth and throat to swallow can be affected, making it difficult to chew and swallow food. Even saliva can be difficult to swallow. When chewing and swallowing are difficult, people are less likely to eat and drink, often causing dehydration and malnutrition.
Dysphagia also increases the chances that food can go “the wrong way”, into their airway instead of into the esophagus and down to the stomach. “Aspiration” is when airway invasion occurs below the level of the vocal folds and increases the risk of choking and pneumonia. If you notice that the person is throat clearing, coughing/choking during or immediately after meals, or has a “wet” or “gurgling” sounding voice, you should talk to their physician right away, as these are signs of aspiration. You should also consider being certified in CPR in case of choking.
Dysphagia can also increase social isolation because people with trouble swallowing may feel insecure about eating in front of others. It’s a complicated effect of brain injury, but with the right support and management techniques, it’s possible to manage dysphagia and keep a healthy diet
How to manage dysphagia
Work with a health professional who specializes in swallowing disorders
Speech language pathologists (SLP), dietitians (RD) and occupational therapists (OT) are all trained in the assessment and management of patients with dysphagia, each with a unique role.
A speech-language pathologist is a health care professional that helps people with speech, communication, and swallowing. They are involved in both the acute and rehabilitation stages of brain injury recovery, as head injuries can result in significant challenges for communication and activities of daily living (ADLs) such as eating and drinking. Depending on the extent of dysphagia, the speech-language pathologist will recommend different coping methods, such as a modified texture diet, and treatments to make swallowing easier and help strengthen the swallowing muscles.
A dietitian is a professional who understands the digestive tract. They work closely with the speech-language pathologist to ensure those with swallowing difficulties receive the nutrients they need to thrive regardless of diet texture. They might suggest supplements to ensure sufficient calorie consumption.
An occupational therapist helps with activities of daily living (ADLs) as well, often in a home setting. This can include eating, drinking, and communicating. They can also help with setting up your home environment to make it as easy as possible for the person with a brain injury to complete tasks independently, including mealtime preparation. They can also recommend specialized utensils, cups or plates that may make eating food much easier.
Make dietary changes
It is very important that the person with a brain injury sees a trained dysphagia specialist, like a speech-language pathologist, for a full assessment to find out what type of food texture and liquid thickness will work best for them. Eating behaviors can be really important too. The following are common guidelines that make sense for everyone:
- Always chew food completely before swallowing
- Avoid distractions like TV, reading etc. at mealtimes
- Avoid talking with food in their mouth
- Limit the amount of food they put in their mouth at one time
- Only eat when alert and well rested
- Remain sitting upright for at least 30 minutes after eating
- Sit up straight when eating (laying back increases their risk of coughing, choking, etc.)
- Swallow a second time to make sure all the food is gone
- Use recommended tools such as cups with sipping lids, straws, or spoons
- Use the tongue or finger to check for any food that might be left in the mouth.