Stroke and Swallowing: What to Expect and How Therapy Helps

Swallowing difficulties - known as dysphagia - affect around 50% of people immediately after a stroke. For many, this improves significantly in the weeks and months that follow. But for others, dysphagia persists and has a significant impact on nutrition, quality of life and recovery.

Why does stroke cause swallowing difficulties?

Swallowing is a complex process involving over 30 muscles and multiple areas of the brain. A stroke disrupts the brain's ability to coordinate these muscles, which can affect any stage of the swallow - from moving food around the mouth to triggering the swallow reflex and safely clearing food and liquid into the oesophagus.

The location and size of the stroke affects how swallowing is impacted. Strokes affecting the brainstem often cause more severe dysphagia than those affecting one hemisphere, though any stroke can disrupt swallowing.

Signs of dysphagia after stroke

• Coughing or choking during or after eating and drinking
• Food or liquid coming back up or out of the mouth
• A wet or gurgly voice after eating
• Feeling of food sticking in the throat or chest
• Difficulty chewing or controlling food in the mouth
• Recurrent chest infections - which can indicate silent aspiration

Silent aspiration - where food or liquid enters the airway without triggering a cough - is particularly important to identify, as it carries a risk of aspiration pneumonia.

How does speech and language therapy help?

An SLT assessment after stroke looks at every stage of the swallow - often using clinical observation, and sometimes instrumental assessment such as videofluoroscopy or FEES (Fibreoptic Endoscopic Evaluation of Swallowing) to see exactly what is happening during a swallow.

From there, therapy may include:

• Exercises to strengthen and coordinate the muscles involved in swallowing
• Techniques to make swallowing safer and more efficient
• Advice on food and liquid textures that are safest to manage
• Strategies for positioning and pacing during meals

Many people see significant improvement with targeted therapy. What is dysphagia? has more on swallowing difficulties generally, and you can read about what to expect from an adult dysphagia assessment if you're thinking about seeking support.