One of the most common medical complications after stroke is aspiration pneumonia. In fact, according to most estimates, one in three stroke survivors will develop pneumonia at least once during their recovery.
Aspiration pneumonia occurs when a person accidentally inhales foreign objects (i.e. solid foods or liquids), which leads to a serious infection in the lungs. Fortunately, there are several strategies you can use to prevent pneumonia after stroke.
To do this, however, it is helpful to understand the root causes of stroke-related pneumonia. Once you understand these causes, you can take more effective preventative measures.
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Causes of Pneumonia After Stroke
The primary cause of pneumonia after stroke is dysphagia, which causes weakness in the muscles used for swallowing.
There are several different types of dysphagia, but most stroke patients develop a type known as oropharyngeal dysphagia. This type weakens the muscles in the throat, making it difficult to move food and liquid from your mouth into your esophagus. It is caused by a stroke in the parts of the brain in charge of muscle control.
The severity of dysphagia can vary, depending on the severity of the stroke. Some stroke patients can still swallow soft food or liquids, while others cannot swallow at all.
Other symptoms of dysphagia besides difficulty swallowing can include:
- Weak voice
- Loss of gag reflex
- Decreased tongue control
These problems can all lead to an increased risk of choking and pneumonia after stroke. When someone accidentally inhales food or liquid, this causes inflammation in the lungs, making it more difficult to breathe. In addition, inhaling foreign objects can bring bacteria into the lungs and cause a serious infection.
Silent Aspiration and the Signs of Pneumonia After Stroke
Aspiration is usually accompanied by fits of coughing and wheezing, as the body tries to force the foreign objects out of the lungs. If the person can cough hard enough, they can usually clear out their lungs before pneumonia can develop.
However, many stroke patients do not have this cough reflex. As a result, they can aspirate food and water without even feeling it. Doctors call this phenomenon silent aspiration, and it can be extremely dangerous. Some studies speculate that as many as 67% of stroke patients experience silent aspiration.
Since silent aspiration can cause serious cases of pneumonia after stroke, caregivers ought to familiarize themselves with the symptoms of aspiration pneumonia. These symptoms are sometimes difficult to notice, but early detection is the key to effective treatment.
A person with aspiration pneumonia can display several symptoms such as:
- Chest pain or heartburn
- Shortness of breath and fatigue, especially while eating
- Blue discoloration of skin
- Coughing up blood, green sputum, or a foul odor
- Bad breath
- Excessive sweating
Sometimes people who aspirate do not display these symptoms for several hours, and they may not have all of these symptoms. However, as soon as the stroke victim displays any of these signs, caregivers should call a doctor.
Diagnosing and Treating Aspiration Pneumonia
A physical exam is usually required to diagnose pneumonia after stroke. Doctors will look for signs such as decreased airflow, rapid heart rate, and crackling in the lungs.
They may also order tests to confirm the presence of pneumonia, such as:
- Chest X-rays
- Arterial blood gas tests
- Sputum and blood culture
Once diagnosed, you should begin treatment right away. Mild cases of pneumonia can be treated with a course of antibiotics, but more severe cases may require hospitalization. At the hospital, the person might receive supplemental oxygen and steroids. In extreme circumstances, they may need the help of a ventilator.
How to Prevent Pneumonia After Stroke
Pneumonia can be a serious, life-threatening condition. But fortunately, it is very preventable. The best way to minimize the risk of pneumonia after stroke is to treat dysphagia. If the stroke patient can regain at least some of their swallowing abilities, this will reduce accidental aspiration and prevent infections from occurring.
The following are a few effective ways to improve swallowing skills and avoid stroke-related pneumonia:
1. Work with a Speech Therapist
Since swallowing muscles are involved in speech, a speech-language pathologist can help patients improve their dysphagia.
The speech therapist will assess the person’s unique conditions, such as their swallowing abilities and overall cognitive function. This assessment will allow them to design a program that meets the patient’s specific needs.
This program will likely include guidance on the types/textures of foods and liquids that a patient can handle. For example, the speech therapist may recommend that the patient eat only pureed foods for a while, and may later progress them to a “chopped” diet where all their food needs to be chopped into small pieces. Additionally, some patients will need to have their liquids thickened in order to minimize the chances of aspirating them.
A speech pathologist will also guide the patient through exercises that help improve swallowing, strength, and coordination. These activities engage neuroplasticity, i.e. the brain’s natural ability to rewire itself and regain lost function.
The therapist may also suggest certain strategies to help prevent aspiration. Examples of strategies include tucking the chin while eating or taking smaller bites.
2. Use Speech Therapy Apps
Some aphasia apps include exercises that retrain the oral motor muscles. This can be a good way to practice your speech therapy exercises at home in between sessions.
The more you practice these exercises, the more you will stimulate neuroplasticity, and the faster you will regain function. Therefore, it is crucial to practice your exercises at home every day, if possible. Speech therapy apps make it easier to do this.
3. Try Electrical Stimulation
Finally, electrical stimulation can also help boost muscle activity and speed up motor recovery. This is true for both arm movement and swallowing.
E-stim for dysphagia works by applying gentle electrical impulses to your throat muscles. This activates the muscles and encourages neuroplasticity.
The best way to use e-stim is to combine it with your traditional speech therapy exercises. Talk to your therapist to determine if electrical stimulation is a good option for you. Do not try e-stim on your neck/throat area without the direct supervision of a trained therapist.
Using Compensation Techniques to Prevent Aspiration and Pneumonia
Speech therapy and electrical stimulation are effective ways to treat dysphagia and prevent aspiration pneumonia after stroke. However, treatment will require consistent effort, and results can take time to appear.
Therefore, to ensure your safety, you may need to take advantage of compensation techniques while eating with dysphagia. The following are a few practices stroke patients can use to reduce their choking risk:
- Drink thick liquids. Thick liquids such as milkshakes and smoothies move slower than thin liquids and actually decrease your risk of choking.
- Sit up straight. Always stay upright when eating or drinking. When you are upright, gravity can help move the food down your throat, which can’t happen when you lie on your back.
- Eat slowly. Don’t rush. Instead, take your time to chew your food completely. Most speech therapists recommend chewing for at least one minute to avoid aspiration.
- Avoid complex foods. Try to avoid foods with varying consistencies, such as chunky soup. These are dangerous for stroke patients with dysphagia and make aspiration more likely.
These techniques can help minimize aspiration risk while you are improving your swallowing skills. However, severe dysphagia patients might need to avoid solid foods entirely and stick to a liquid diet. In extreme cases, the patient may require a feeding tube.
Understanding the Risks of Pneumonia After Stroke
Pneumonia is a common complication of stroke that occurs because of swallowing difficulties. Approximately half of all stroke patients experience these difficulties, which can cause aspiration and respiratory infections if left untreated.
But with the right tactics, it is possible to improve swallowing abilities and reduce a person’s risk of pneumonia.
We hope this article helps you better understand the causes of pneumonia after stroke and how to prevent it.
Featured Image: ©iStock/stefanamer