Medical Conditions Related to Brain Injury
Swallowing Disorders
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A swallowing problem or dysphagia has many causes. One of these causes is damage to the nervous system such as with stroke or traumatic brain injury. Since the swallowing process has three phases, a problem may occur at one or all of these phases.
The first phase of the swallow is the oral preparatory/oral phase.This phase involves the structures of the mouth which manipulate and transfer food from the mouth to the throat. When drinking, for example, the lips are used to close down on the cup or straw and help the liquid stay in the mouth. With food, the tongue is used to transfer the food to the side teeth so that it can be chewed into a fine enough texture to be swallowed. Once ready to be swallowed, the tongue moves to the roof of the mouth which transitions the food towards the base of the tongue where the swallow reflex is triggered. A swallowing disorder at this phase occurs when there is weakness or decreased ability to adequately prepare the liquid or solid food for the swallow. For instance, inability to chew a solid may limit a person to a diet consisting primarily of pureed textures.
The second phase of the swallow is the pharyngeal phase. Once the swallow is triggered at the back of the mouth, the liquid or food moves through the pharynx to enter the esophagus. The transition of the food from the back of the throat to the esophagus typically occurs in one second. During the swallow, automatic actions within the throat are completed to keep food from entering airway. If there is weakness or discoordination at this level, food can enter into the airway. This is called aspiration. Aspiration causes many problems one of which is pneumonia.
The third and final phase of the swallow is the esophageal phase. At this level, the food passes through a tube-like structure or the esophagus to enter the stomach. Problems at this level can occur if the muscles of the esophagus do not allow the food to move smoothly into the stomach. The food may come back up causing discomfort that may impact the person’s desire to eat.
Signs and symptoms of a swallowing problem include the following: leaking of food or liquid from the mouth, excessive feeding time, gurgly or wet vocal quality, coughing or increased congestion associated with feeding, recurring pneumonia or respiratory problems, decreased desire to eat, and difficulty gaining weight.
A swallowing evaluation by a speech -language pathologist certified by the American-Speech-Language-Hearing Association and licensed by the state of Georgia with an expertise in this area helps identify the problem, assists with compensatory strategies to improve the swallowing process, and makes a referral for additional testing if needed. The speech-language pathologist is but one of many health care professionals who works to help manage the swallowing problem.
Treatment depends upon the nature of the problem. Treatment may consist of exercises to improve strength and coordination of oral motor movement, positioning, special utensils, or food consistencies. These treatments may help to improve the ease, safety, and pleasure of the feeding process.
Further information is available at the following website:
www.asha.org - American Speech-Language-Hearing Association
Barb Aleksa-Parr, M.A./CCC-Sp contributed this section. She is a speech pathologist with numerous years of experience. Ms. Aleksa-Parr treats pediatric inpatients and outpatients at Children’s Healthcare of Atlanta at Egleston.