Swallowing Rehabilitation in Paralyzed Patients

In this article, we will talk about swallowing disorder in paralyzed patients, and the treatment of dysphagia with its medical expression. With swallowing rehabilitation, it is aimed that the patient can take the liquid and nutrients required for his body safely through the mouth, that is, without escaping (aspiration) into the trachea and lungs. For general information about dysphagia and aspiration, you can refer to our article “ Swallowing Difficulty in Paralyzed Patients ”.

How is swallowing rehabilitation done?

In swallowing rehabilitation, compensatory techniques (modification of food and fluids, correction of patient posture, changes in swallowing style) and some rehabilitative methods are used.

Compensatory techniques do not aim to improve swallowing physiology or swallowing-related neural networks, they are effective in providing adequate nutrition and reducing aspiration (1). Posture techniques such as retracting the chin and swallowing maneuvers work by moving the bite away from the weak side and changing the dimensions of the pharynx. Changing the consistency of food is also a compensatory technique. Increasing the consistency slows down the movement of the morsel, keeping it together and reducing aspiration. There are no standard guidelines for consistency change. The method of administration is affected by the type, temperature, method of preparation of liquid and food, the nature of the thickener and patient characteristics. Generally, compensatory and rehabilitative techniques are used together (2).

Rehabilitation techniques focus on exercises that increase the strength and endurance of the mouth and tongue muscles. This increases the pressure exerted by the muscles. Exercises such as shaker exercises, Mendelsohn maneuver strengthen the swallowing muscles. Heat (thermal) and tactile stimuli can improve sensation. It is not clear how the exercises performed separately for the movements in certain stages of swallowing are reflected in the dynamic swallowing process. In some rehabilitation methods, movement learning principles and functional swallowing process are emphasized. McNeill dysphagia therapy program is one of them (3). With methods such as transcranial magnetic stimulation (TMS), pharyngeal electrical stimulation (PES) and neuromuscular electrical stimulation, parameters such as aspiration, residual food in the pharynx, and hospitalization can be improved.

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Does swallowing disorder go away on its own?

Yes, swallowing may improve spontaneously in some stroke patients. However, treatment should not be delayed with this expectation. Because, inactive, unused muscles, there is a meltdown. If swallowing rehabilitation is not applied, the muscles of the person who recover spontaneously will be weakened (5).

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