1. Eating and Drinking Dysphagia after stroke This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.

2. By the end of the session you will be able to: List and briefly explain the steps to a normal swallowing process List and briefly explain the steps to a normal swallowing process Explain signs and symptoms of swallowing problems Explain signs and symptoms of swallowing problems Describe physical consequences of swallowing problems Describe physical consequences of swallowing problems Describe emotional / psychological consequences for the patient and the carer Describe emotional / psychological consequences for the patient and the carer

3. Dysphagia and Stroke Stroke is the most common cause of dysphagia Stroke is the most common cause of dysphagia Approximately half of stroke survivors will have difficulty swallowing Approximately half of stroke survivors will have difficulty swallowing Some recover quickly (approximately 2/3 rd recover within 2 weeks) Some recover quickly (approximately 2/3 rd recover within 2 weeks) Sometimes following a stroke people will have on-going dysphagia Sometimes following a stroke people will have on-going dysphagia The type of difficulty will depend upon the area of the brain damaged. The type of difficulty will depend upon the area of the brain damaged.

4. What do we need for swallowing? Group Activity: Group Activity: Eat a biscuit. Tell the group what actions or events you notice when you do this. E.g. chewing action Eat a biscuit. Tell the group what actions or events you notice when you do this. E.g. chewing action Discuss this as you notice the actions, rather than when you have finished the biscuit. Discuss this as you notice the actions, rather than when you have finished the biscuit.

5. WHAT DO WE NEED FOR SWALLOWING? HEAD POSITION BODY POSITIONJAW MOVEMENT MUSCLES IN PHARYNX TEETH LIPS LARYNX SALIVA TONGUE MUSCLES SENSATION HARD PALATE CHEEK MUSCLES SOFT PALATE

6. Normal Swallow Process

7. Normal Swallow

8. Signs and Symptoms of Dysphagia

9. Signs and symptoms of dysphagia Dribbling Dribbling Difficulty taking food or drink from a cup or spoon Difficulty taking food or drink from a cup or spoon Facial weakness Facial weakness Holding food in the mouth ( pooling) Holding food in the mouth ( pooling) Difficulty chewing Difficulty chewing Wet, gurgly voice Wet, gurgly voice SOB SOB Change in colour Change in colour Watery eyes Watery eyes Coughing or choking Coughing or choking Increase in temperature Decreased sats Chest infection Weight loss Refusing food Aspiration pneumonia

10. Group task 1 What are the possible physical consequences for a patient who suffers from dysphagia after stroke?

11. Possible physical consequences of dysphagia for a patient Weight loss Weight loss Chest infection Chest infection Aspiration pneumonia Aspiration pneumonia Dehydration Dehydration Malnutrition Malnutrition Weakness, lethargy Weakness, lethargy Compromised immune system Constipation UTI Poor oral hygiene Sore, dry mouth

12. Group task 2 Identify the possible emotional / psychological consequences of dysphagia after stroke upon a) the patient and b) the carer. Identify the possible emotional / psychological consequences of dysphagia after stroke upon a) the patient and b) the carer.

13. Emotional / psychological consequences of dysphagia For the patient For the patient Depression Depression Social isolation Social isolation Reduced quality of life Reduced quality of life Avoidance of eating Avoidance of eating No longer enjoys mealtimes No longer enjoys mealtimes Worry about deterioration Worry about deterioration Worry about choking Worry about choking For the carer Inability to cope Depression Increased workload in meal preparation Worry and anxiety Social isolation Guilt Reduced quality of life

14. summary The swallow is process is complex. You now are aware of the signs that it may not be safely working. The swallow is process is complex. You now are aware of the signs that it may not be safely working. Refer to a Speech and Language Therapist for a full dysphagia assessment. Your observations make up part of this assessment. Refer to a Speech and Language Therapist for a full dysphagia assessment. Your observations make up part of this assessment.

15. Thank you very much for listening Any questions