Dysphagia is a common physical effect of brain injury that makes it difficult to swallow.
It mostly affects people in the early stages of their severe brain injury recovery.
To help you manage this problem, we’re giving you a quick crash course on treating dysphagia after head injury. We’ll also show you some easy exercises you can do to improve your swallowing skills!
What Causes Dysphagia After Head Injury?
Swallowing, though it looks like a simple action, actually involves 26 different muscles in the mouth, neck, and throat.
All 26 muscles must coordinate with each other to get food and liquid from your mouth down your throat. To accomplish this, your brain sends signals to each muscle, telling them precisely what to do and when to do it.
If a head injury damages the regions of the brain responsible for this, swallowing problems will arise.
How Does Swallowing Work?
Before you can know how to treat dysphagia after head injury, you’ll need to know how swallowing works.
The swallowing process consists of four stages:
- Oral preparatory stage. In the first stage, your brain prepares your mouth for food by triggering saliva production, which will make chewing and swallowing easier.
- Oral stage. This is the chewing stage, but chewing requires more than just your teeth! Your tongue, cheeks, and lips all work together to mash food into a small, round mass, which the tongue moves to the back of the throat to prepare for the third step.
- Pharyngeal stage. When the food reaches the back of the throat, the pharynx muscles contract to push the food down into the esophagus. Other muscles also contract to close off the trachea and prevent choking.
- Esophageal stage. Finally, the muscles in the esophagus push the food into the stomach.
Depending on where the brain damage occurred, you can have problems with any one of these stages.
For example, your brain might no longer signal your mouth to produce saliva, which will make food stick in your mouth and throat.
Or your brain injury could weaken your tongue and lip muscles, which will not only make swallowing impossible but also cause slurred speech.
Signs of Dysphagia After Head Injury
Here are a few signs you should watch out for if you suspect your loved one might have dysphagia after their head injury:
- Coughs after swallowing
- Uncoordinated chewing
- Weak voice
- Grimaces while swallowing
- Eats slowly
- Complains about pain behind the sternum when eating
- Pockets food in cheeks or gums
- Wet, gurgling cough
There are also several swallowing tests that doctors will use to confirm that someone has dysphagia. These include:
- Barium Swallow Test. The patient swallows a fluid with barium (a dye that shows up on X-ray) to see how the muscles function.
- Dynamic Swallow Study. Patient chews and swallows food coated with barium while under an X-ray. This lets the doctors know how well you can chew.
- Fiber-Optic Swallow Evaluation. With this test, doctors put a small tube with a camera down into the throat to observe how well the esophageal muscles move.
- Hydration assessment. This is done to make sure the patient is getting enough water. If they aren’t, that’s a sign they might have trouble swallowing fluid.
- Manometry. Very similar to the fiber-optic test, except this test measures muscle pressure when swallowing. It’s a good way to tell if weak muscles are causing you to choke.
Treatment for Dysphagia
There are many ways to treat dysphagia after head injury.
The most severe dysphagia patients will need to use a feeding tube that delivers food directly to the stomach. This prevents choking and malnourishment.
For less severe patients, a speech therapist can show you techniques to improve your swallowing skills!
Here are four of the easiest exercises you can do at home to overcome dysphagia:
1. Straw and Paper
- Cut up paper into 5 small pieces and place the pieces on a table.
- Place a cup on the table.
- Put a straw in your mouth. Now, while holding the straw above a piece of paper, suck through it. The paper should stick to the bottom of the straw.
- Keep sucking on the straw and move the paper into the cup.
- Repeat until all the pieces of paper are in the cup.
This exercise strengthens your cheeks and tongue.
2. Dry Swallow
- With your mouth empty, try to swallow your saliva.
- Squeeze you swallowing muscles as tightly as you can.
- Cough at the end.
You can also try holding your breath as you swallow. This uses more muscles.
3. Tongue Exercises
- Stick out your tongue. Place a spoon against your tongue, then push your tongue against it for 10 seconds. Repeat 5 times.
- Place your tongue right behind your teeth. Then, curl your tongue towards the back of your mouth. Hold for 10 seconds. Repeat 5 times.
5. Effortful Swallow
- Swallow as hard as you can.
- While doing so, push your tongue up to the roof of your mouth.
If you do these activities frequently enough, you will rewire your brain and recover muscle strength and coordination in your mouth!
What Foods Can You Eat if You Have Dysphagia After Head Injury?
You might be wondering what you can eat while you are working on improving your swallowing skills.
Your speech therapist will create a personalized diet that fits your needs, but some foods they might suggest include:
- Pureed foods. Patients who have almost no chewing abilities should purée their meals. Pudding and yogurt would also work.
- Soft foods. These require more chewing but are still easy to swallow. Examples: cottage cheese, mashed potatoes, and scrambled eggs.
- Soft-solid foods. These are foods that need even more chewing but are easily cut and mashed, such as tender meats, fruits, and vegetables.
Avoid crunchy or sticky foods such as nuts and crackers until your speech therapist gives you permission.
How Long Does Dysphagia Usually Last?
For most brain injury patients, dysphagia will improve after a few months of rehab.
There are several signs that doctors look for that indicate swallowing will come back soon, including:
- The person is alert and understands what is happening.
- They mostly have trouble controlling their mouth muscles, not their throat muscles.
- They can take deep breaths.
- If food gets stuck, they can cough it up.
If these signs are not present, that doesn’t mean the person will never overcome their dysphagia. It will just take more time and effort.
Living with Dysphagia
Swallowing is a complex process that involves multiple areas of the brain and over two dozen muscles. Damage to any of these will lead to dysphagia.
Since dysphagia is so dangerous, it’s crucial to find a speech therapist who will teach you exercises that improve your swallowing skills.
As you practice those swallowing exercises, your brain will relearn how to control your mouth muscles again, and your dysphagia will improve.