Presentation on theme: "NHS Greater Glasgow & Clyde Advancing Skills in Stroke Care Swallowing problems after stroke."— Presentation transcript:
NHS Greater Glasgow & Clyde Advancing Skills in Stroke Care Swallowing problems after stroke
Stroke and dysphagia Dysphagia is the term used for swallowing difficulties Approx 60% of stroke patients will have some degree of dysphagia at the acute phase. Approx. 20% of stroke patients with dysphagia develop aspiration pneumonia. More frequent in patients with haemorrhagic stroke. The majority of people will improve within 6-7 weeks post stroke.
Oesophageal stage This stage is also under involuntary control This stage involves the passage of food/fluids from the oesophagus to the stomach.
Oral stage problems Drooling/Loss of food or fluids from lips Residue of foodstuffs in the mouth Loss of taste or smell Incomplete soft palate seal Loss of food/fluids into the pharynx before the swallow is triggered
Pharyngeal stage problems Unable to trigger swallow Delayed swallow trigger Reduced protection of the airway - leading to penetration/aspiration No cough reflex Pharyngeal muscles are weak Upper oesophageal sphincter dysfunction
Oesophageal stage problems The speech and language therapist is not really involved in problems at this stage as they are unable to assist with problems of oesophageal function Medical team investigation and management
Aetiologies of Dysphagia NEUROLOGICAL CVA Motor Neurone Disease Parkinson’s Disease Multiple Sclerosis Myasthenia Gravis Guillain-Barre Disease Cerebral Palsy Dementia (also behavioural) Brain Tumour Head Injury
Food Consistencies Texture A - a smooth, pouring consistency that cannot be eaten with a fork eg tinned tomato soup. Texture B – smooth consistency, drops rather than pours from spoon eg thick custard. Texture C – a thick, smooth consistency. Can be eaten with a fork and can be moulded layered and piped eg mousse
Texture D – food that is moist with some variation in texture. Easily mashed with fork and little chewing required eg flaked fish in sauce / macaroni cheese Texture E – Soft moist food that can be broken into pieces with a fork eg sponge and custard, tender meat casserole
Thickened Fluids Stage 1 (syrup) can be drunk through a straw and from a cup. Leaves a thin layer on the back of the spoon. Stage 2 (custard) Cannot be drunk through a straw, can be drunk from a cup. Leaves a thick coat on back of the spoon. Stage 3 (pudding) cannot be drunk from a straw or cup. Needs to be spooned. A bit like thick custard
Short-term signs of dysphagia Choking or coughing when eating/drinking Change of colour during or eating/drinking Wet, gurgly voice Shortness of breath Loss of food or drink from the mouth Pocketing of food or drink in the mouth Nasal regurgitation
Long-term signs of dysphagia Loss of weight with anorexia and dehydration Recurrent chest infections Frequent episodes of high temperatures
Points to Consider when Feeding Is the person alert? Is the person positioned upright with their body in mid-line? Is the person’s mouth clean? Discourage conversation when eating Use small spoonfuls Check the person has swallowed before giving the next spoonful
Tell the patient what food or drink you are giving them Sit in front of the person or on their ‘good’ side if they have a neglect Check in the mouth at the end of meal for pocketing in the cheeks Keep the person upright for 30 minutes after a meal
Watch out with ice -cream as it starts off as a puree but melts in the throat to a normal fluid.
Dysphagia and Quality of Life Ekberg et al (2002) article on effects of dysphagia on quality of life. Only 45% of the 360 patients in the study enjoyed mealtimes. 41% felt anxious or panicky when eating. 36% avoided eating in public 1/3 of those on modified consistencies still felt hungry/thirsty after a meal. Affects, self-esteem, socialization and dignity.