Dysphagia is an all-too common adversary of neuro-rehab patients, and the professionals who care for them.
Some studies suggest the swallowing disorder is experienced in as many as 93 per cent of people admitted to brain injury rehab centres (Hansel et al, 2008).
It will affect around one in two stroke survivors, according to the Stroke Association, and roughly at least a third of people with MS.
Meanwhile, over 80 per cent of people with Parkinson’s may be affected (Suttrup et al, 2016).
Its impact on the patient can be profound. Not only does it reduce life quality and independence – those key indices of rehabilitation – but can also complicate medication intake and cause malnutrition.
It is also implicated in infections such as aspiration pneumonia which can be fatal.
After a brain injury, damage to the main swallowing centres of the brain or to the nerves and muscles controlling swallowing can cause dysphagia.
But the brain injury can influence swallowing in other ways too, as brain injury charity Headway explains in its dysphagia factsheet:
“If the senses of taste and smell are impaired then the oral preparatory stage will be affected and the production of saliva will not be stimulated.
“This stage can also be affected by severe cognitive issues.
People may not understand what food is or have an awareness that they are about to eat.
“The effects of brain injury can also mean that people sometimes aren’t aware of problems such as food going down the wrong way, because their choking reflex doesn’t work.
This is known as silent aspiration and is one of the reasons that aspiration pneumonia can occur.”
Speech and language therapists employ a range of therapy techniques aimed at triggering the swallowing reflex and strengthening muscles needed for chewing and swallowing.
Once the patient is in a residential care or community setting, carers and loved ones may also have a key role to play in minimising the impact of the condition.
“Dysphagia can mean that mealtimes become a struggle,” says Helen Willis, dietitian at Wiltshire Farm Foods.
“Not only is eating a slow process, but it can also be a scary one.
“The risk of choking or aspiration, the inhaling of food into the lungs, is high and can lead to frequent chest infections and pneumonia.”
A texture-modified diet may, therefore, be required to counter these risks.
But home-blended food brings with it its own problems, on top of reduced appetite caused by illness and apprehension about swallowing.
Helen says: “Being presented with a puréed meal that doesn’t resemble food that a patient is used to can make the eating process even harder.
“People with dysphagia still eat with their eyes so if a meal is not visually appealing then it can fail to trigger salivation, further hindering an already-weakened swallowing process.”
Density of nutrition, or rather lack of it, is a major factor too.
“Adding water to aid the blending process of food at home can dilute the nutritional content, meaning patients need to eat a higher volume of food to achieve the same nutritional intake at a time when they are more likely to have a reduced appetite.
“Often patients with dysphagia struggle to get the calories and nutrition they need, meaning each bite they do take needs to be packed with as much protein, calories, vitamins and minerals as possible.
“Serving larger portions with fewer calories does little to improve mealtimes for dysphagia patients since the meal may appear more intimidating and is unlikely to be finished.”
In her role as an in-house dietitian at Wiltshire Farm Foods, Helen is tasked with finding solutions to such problems.
One alternative to home-blended food for dysphagia patients she has influenced is the PuréePetite range, part of the Softer Foods range of texture modified meals.
They provide smaller, and therefore more manageable, portions. Yet deliver the same nutritional value as a standard-sized dish.
They are “energy dense” to serve up a similar calorie and protein content as larger dishes, containing a minimum of 500 calories at least 20g of protein.
They are also suitable for patients requiring a Level 4 Puréed diet in line with the recently introduced IDDSI (International Dysphagia Diet Standardisation Initiative) food and drink texture standards.
Crucially, dishes in the range are shaped to look like a non-blended meal – “making them more appealing, encouraging patients to eat”, says Helen.
Another weapon in the fight to mitigate dysphagia’s impact is the oral nutritional supplement (ONS). Fortifying or adding an ONS to the patient’s diet can deliver high levels of protein or calories in a low volume.
Whichever option is taken, the power of good nutrition in rehabilitation should not be underestimated, or compromised because of swallowing difficulties, says Helen.
“Eating a well-balanced meal that meets the patient’s nutritional needs whilst being at a safe texture can lead to improved recovery times and a better quality of life.
“Healthcare professionals should consider all options when it comes to providing the best diet for their dysphagia patients, and always be aware of the potential challenges of home-blended meals.”
To discover a range of Softer Foods products that are IDDSI compliant and designed to help your patients and residents with dysphagia visit www.specialistnutrition.com to request a brochure or book a tasting session with Wiltshire Farm Foods.