Wednesday, August 26, 2015

My Conclusions About Swallowing Training

Rebecca Dutton
Home After a Stroke
August 25, 2015

Impaired swallowing has lingered for 11 years after my stroke.  So I am thrilled that 3 strategies improved my ability to swallow - neck elongation, increased sensory awareness, and strengthening hip adductor muscles (see 8/15/15 post about these muscles).

#1.  Many ST websites recommend making swallowing safer by lowering the chin towards the chest.  However, many people sit or stand with their head jutting in front of their trunk (see arrow).  Lowering the chin when the head is in this forward position may collapse throat structures.  This "chin tucked" strategy never stopped pills from going into the opening for my lungs (trachea).

Instead I make my neck as long as possible by making sure my head is in a straight line with my trunk before I drop my chin slightly.  This maneuver helps send pills down my esophagus to my stomach.

#2.  Stroking my tongue with a soft toothbrush after I read about PONs therapy taught me the hemiplegic (paralyzed) side of my tongue was numb.  I decided to start chewing food on the hemiplegic side of my mouth.  This makes me swallow more symmetrically which makes me more aware of when food touches the hemiplegic side of my throat.  This greater sensory awareness tells me when I swallow food while I am taking a breath.

#3.  When squeezing a ball between my knees I felt increased muscle tone in my throat muscles. I know muscle tone cascades down a limb from the shoulder to the hand.  It seems reasonable that muscle tone of midline muscles would cascade up from the pelvic floor.  Now I can quickly tighten my throat to stop food that slips to the back of my throat when I am taking a breath.  This gives my tongue time to shove the food back to the front of my mouth.  Authors I quoted in my post on urinary incontinence said midline stability requires coordination among three "diaphragms” - the pelvic floor, the diaphragm we breath with, and throat muscles.

Bottom Line:
      1. Swallowing training may require an interdisciplinary approach.
      2. Brain plasticity 11 years post-stroke is amazing

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1 comment:

  1. I often stroke the affected side of my throat when swallowing. It seems to help too.