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 increase the chances that food can go “the wrong way”, into their airway instead of into the esophagus and down to the stomach. These can be signs of aspiration (food or liquids going into the airway), a condition that can put the person at risk of choking and pneumonia. If you notice that the person is throat clearing, coughing or choking during or after meals, you should talk to their physician right away. 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.
A speech language pathologist (SLP) is a professional that helps people with speech and throat conditions, including dysphagia. They are generally involved in the acute and rehabilitation stages of brain injury recovery, as throat issues cause significant challenges for activities of daily living (ADLs) such as eating and drinking. Depending on the extent of dysphagia, the SLP will recommend different coping methods and treatments.
A dietitian is a professional who understands the digestive tract, including the muscles that support swallowing. They are often able to identify the causes of dysphagia and recommend safe swallowing strategies, including a change in diet texture. When chewing is an issue, often mashing food or pureeing food will be very helpful. For those who have difficulty with liquids, often thickening them is a good idea.
An occupational therapist helps with 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. With respect to dysphagia they can 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 (SLP, RD or OT) 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 meal times
- 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.