|Sometimes a stroke can cause difficulty with the process of swallowing, known as dysphagia. The ability to chew food or swallow secretions, food and drink can be affected. If material is not swallowed safely it can be aspirated into the airway causing a severe chest infection known as aspiration pneumonia. This can be very serious and have far-reaching effect on recovery and rehabilitation. A speech and language therapist can complete a Clinical Bedside Assessment of swallowing to see if clients are safe to eat and drink orally. They will liaise with the MDT, for example Nursing staff, Physiotherapy and Dietetics. Dietitians have a particular role here if oral feeling isn’t safe and alternative non-oral methods need to be considered to meet the individual’s nutritional needs, such as an NG feed or PEG feed.
Speech and Language Therapists assess what types of food and fluid are safe to manage. They might recommend changes to food texture, to foods that are easier to manage, for example smooth puree textures like yogurt, or a fork-mashable texture like a shepherd’s pie or bananas. Some normal texture foods, such as chewy meat or dry biscuits, might be too difficult for people to manage.
If drinks are going down the wrong way, they can be thickened. Thicker fluid moves more slowly and provides more time for the swallow to be coordinated safely. National descriptors are used to classify the viscosity of thickened fluids. Liaison with a dietitian may happen here to ensure that patients are still meeting their nutritional and hydrational needs, as this can have a great impact on stroke recovery.
Safe positioning for eating and drinking is vital. Some compensatory strategies can also help protect the airway, for example tucking the chin down when swallowing. In some cases, restorative strategies can be suggested to actually improve swallowing function.
During the patient’s stay in hospital, SLT will continue to be involved for ongoing assessment and therapy of communication as appropriate. An important role for the SLT team is patient and family education about how communication may have been affected by the stroke. SLTs will use accessible information to explain stroke and aphasia to patients.
SLTs can facilitate non-verbal communication, for example by providing pictures or photos of key words for clients to point to and show what they want or how they are feeling.
Individuals’ speech and language often shows some spontaneous recovery. Recovery can be further facilitated by targeted and regular SLT intervention.
When patients have communication difficulties, the SLT may also be involved in mental capacity assessment about specific decisions, for example, choosing where to go on discharge from hospital. SLTs can use simple language, choices and pictures to facilitate this.
Client describes transition from hospital to home