บำบัดฟื้นฟู “ภาวะกลืนลำบาก” ในผู้ป่วย “โรคหลอดเลือดสมอง”

Dysphagia is a significant complication found in up to 50% of stroke patients.
Most survivors often experience problems with movement, balance, behavior, and emotional changes, as well as impairments in cognition, communication, and swallowing difficulties. These issues reduce their ability to eat independently, negatively affecting the rehabilitation process, impacting the patient&#8217;s quality of life, and placing a heavy burden on their caregivers.
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<h2>What are the adverse effects of dysphagia?</h2>
Dysphagia is a disorder that can lead to aspiration pneumonia caused by inhaling food and liquids, or result in insufficient nutrient intake. In some cases, doctors may consider feeding through a nasogastric tube because aspiration pneumonia prolongs hospital stays and can be a major cause of death. Therefore, patients should be evaluated to determine the cause and severity of dysphagia to receive proper rehabilitation advice from physiatrists and occupational therapists. This helps prevent complications from dysphagia, reduces the risk of aspiration, and lessens the burden on families caring for the patient.
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<h2>How to recognize if a patient has dysphagia</h2>
Physiatrists, occupational therapists, and nurses will assess swallowing function loss to reduce risks from complications. Signs of dysphagia include choking, coughing, hoarseness, or a wet voice during swallowing of liquids and food, feeling like food is stuck in the throat, or food remaining in the mouth after swallowing. These symptoms can cause fatigue and rapid breathing during meals.
Swallowing is the process involving the oral cavity to the esophagus, controlled by a complex brain nervous system that both stimulates and inhibits the muscles used in swallowing. This process moves chewed food from the mouth to the stomach and intestines for digestion and absorption of nutrients beneficial to the body.
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Occupational therapists rehabilitate dysphagia to improve patients&#8217; quality of life. When dysphagia is identified, close care and guidance from occupational therapists are necessary to ensure safe swallowing by following these steps:
<ul>
<li style="font-weight: 400;">Adjust the texture of food and liquids to suit the patient&#8217;s ability, possibly by adding thickeners to reduce the risk of aspiration.</li>
<li style="font-weight: 400;">Maintain oral and dental hygiene before and after every meal to remove mucus or food residues in the mouth, reducing bacterial accumulation and lowering the risk of pneumonia.</li>
<li style="font-weight: 400;">Exercise muscles involved in swallowing, such as muscles around the mouth and tongue, by pursing lips, smiling, opening and closing the mouth alternately, and practicing sounds like “ah-ee-oo.” For tongue muscle exercises, physiotherapists will have patients stick out their tongue as far as possible, touch the upper lip with the tongue tip, touch the corners of the mouth alternately, and practice sounds like “la-la-la, ta-ta-ta.” Progress is recorded to plan further training.</li>
<li style="font-weight: 400;">Adjust swallowing posture according to the abnormalities found in each patient, such as bending the head down, tilting, or turning the head to one side to swallow safely. For severe cases, physiotherapists may recommend additional swallowing techniques depending on the severity or symptoms, such as swallowing with maximum effort or coughing after each bite to help clear residual food.</li>
</ul>
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<h2>Recommended food characteristics for patients with dysphagia</h2>
Foods should be low in fiber, with texture modified by blending instead of normal solid food. Liquids should be thickened using tapioca or cornstarch to create a uniform semi-solid, semi-liquid consistency similar to wet starch. The food should not be coarse, should stimulate swallowing, and reduce secretions. Avoid very hot or cold foods, thin liquids, foods containing milk, mixed solid and liquid foods, and ice cream, as these may increase the risk of aspiration. However, the food texture must be assessed for suitability before feeding the patient.
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<h3>Proper positioning helps patients eat more easily</h3>
During meals, position the patient sitting upright or in a hospital bed with the head elevated about 90 degrees and hips/knees bent. Also, create a calm environment and atmosphere, talk to the patient only as necessary, and do not leave the patient alone while eating. The feeder should sit or be positioned lower than the patient&#8217;s eye level, allow time for swallowing without rushing, and if there is a gurgling sound in the throat after swallowing, have the patient clear their throat or cough several times to prevent aspiration. After eating, the patient should remain in a sitting position with the head elevated 30–60 degrees for at least 30 minutes.
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<h3>10 Easy Tricks to Follow Before Swallowing Training</h3>
<ul>
<li style="font-weight: 400;">The patient must be fully aware.</li>
<li style="font-weight: 400;">Ensure adequate rest.</li>
<li style="font-weight: 400;">Stimulate saliva production, e.g., with sour or sweet foods.</li>
<li style="font-weight: 400;">The feeder should be at the patient&#8217;s eye level.</li>
<li style="font-weight: 400;">Avoid conversation during feeding.</li>
<li style="font-weight: 400;">Feed 5–10 cc or one bite at a time.</li>
<li style="font-weight: 400;">Place food or medicine on the stronger side of the tongue.</li>
<li style="font-weight: 400;">Do not feed food too deep into the mouth.</li>
<li style="font-weight: 400;">Encourage coughing after swallowing.</li>
<li style="font-weight: 400;">Avoid using straws for food and liquids.</li>
</ul>
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Rehabilitation Medicine and Physical Therapy Center, Phyathai 3 Hospital, 16th Floor 
Open daily from 08:00 to 19:00 
Phyathai Call Center 1772 
or Tel. 0-2467-1111 ext. 1603 and 1602

"Dysphagia" is a significant complication found in up to 50% of stroke patients. Dysphagia is a disorder that can lead to aspiration pneumonia from inhaling food and liquids, or dysphagia can result in patients receiving insufficient nutrition.

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