Speech & Swallowing
It is hard to predict the impact of a stroke. Once it occurs, it is necessary to seek medical attention from doctors and speech therapists as soon as possible to minimise the impact of a stroke on communication and swallowing abilities.
Impact on communication
Due to damage to the brain area responsible for communication, patients may have difficulty finding appropriate words to express themselves, resulting in "dysfluency" or "circumlocution". They may also use wrong words, mispronounce words, or involuntarily repeat specific short phrases. Even if they manage to speak fluently, the content may be disorganised, and it may lack a clear theme.
In terms of language comprehension, patients may only understand certain words, and they may not be able to fully understand what is being said.
After a stroke, patients’ reading and writing ability may also be hindered. They may confuse words with similar meanings or spellings.
When the nerves in the brain are damaged, control of facial and oral muscles (including lips, tongue, and jaw) may be affected. Patients may have slurred speech, and they may also drool or have difficulty swallowing.
Apraxia of speech
When the brain's speech control area is damaged, patients’ ability to speak may be affected. They may know exactly what they want to say, but since they cannot properly coordinate their muscles, they may say something different from what they intend, or may not be able to say anything at all. Patients may only be able to say some "automatic language" (words and phrases that can be said naturally without much thought), such as counting numbers or reciting the ABC song.
Swallowing difficulties (Dysphagia)
Patients with stroke-induced swallowing difficulties can have different symptoms. One common symptom is limited movement of the tongue. This can prevent the formation of a food bolus or lead to difficulty pushing the bolus timely and smoothly into the pharynx for swallowing.
Another common symptom occuring at the pharyngeal phase, mainly due to incomplete closure of the velopharynx, is nasal regurgitation (i.e. the bolusflows into the nasal cavity instead of the pharynx). When the ability of the pharyngeal muscles to move is weakened, the food bolus may not be normally swallowed, leading to food residues in the pharyngeal recess. This may increase the risk of choking on the trachea, and aspiration pneumonia caused by food bolus penetrating into the lungs.
Over time, patients may experience malnutrition, dehydration, and weight loss due to inadequate nutrient absorption.
The impaired physical mobility of stroke patients may hinder oral care. Due to the lack of limbs, motor coordination, and intelligence, stroke patients may not be able to perform oral care independently. Foreign studies have shown that more than one-third of stroke patients have difficulty using toothbrushes. The more severe the activity limitations, the more difficult it is to clean their teeth, and hence support from caregivers is essential.
Stroke is a common cause of swallowing disorders (dysphagia). Studies have shown that swallowing disorders are associated with oral ulcers and dry mouth. If the ability of patients to remove oral food residue is impaired, oral hygiene is more likely to deteriorate. When assisting patients with swallowing disorders to clean their mouths, extra support should be provided to reduce the risk of choking on toothpaste or food residue.
Tips for oral care
Individualized care: Patients may require different levels of support from caregivers and medical teams.
During toothbrushing, patients should be assisted to sit upright or semi-reclined.
Encourage patients to spit out the toothpaste after brushing (should consider individual patient’s oral function).
Use the handle of a second toothbrush or a dental bite rest (mouth prop/rest) to keep the mouth wide open and clean as much as possible. If necessary, the handle of the toothbrush can be adjusted for easy use under the guidance of an occupational therapist.
If the patient’s swallowing ability is weak, use a toothbrush with suction function.
During the process of oral care, give patients appropriate rest and opportunities to dry swallow saliva. Hold the hand of stroke patients with impaired physical mobility and help them brush their teeth slowly to gradually improve their independence in oral care.
Regularly provide oral care for dry mouth to maintain humidity and comfort.
*When caring for patients with swallowing difficulties, caregivers should pay attention to and follow the recommendations of speech therapists.