Following brain injury, the person with dysphagia may have additional problems that can have a significant impact on their ability to eat and drink safely.

Other factors to consider when supporting someone with dysphagia include:

Cognitive Problems
Cognitive Problems can have marked impact on the person’s ability to eat and drink safely and on their understanding of the problem. Difficulties maintaining attention and increased distractibility may cause the person to stop attending to the eating/drinking process. A busy, distracting environment may make the process more difficult.  A decrease in attention may increase risk to the person.  Dysphagia risks may arise from:

  • Impaired memory and executive functioning, including decreased insight and awareness may mean the person with dysphagia is unaware of the problem.
  • The person may not be able to independently remember and implement strategies to help safe eating/drinking.
  • Problems of disinhibition and impulsivity can cause the person to eat/drink too much and/or too quickly without giving themselves time to adequately chew and swallow. This may result in them appearing to ‘cram’ in too much food/fluid thus significantly overloading their mouth.
  • Difficulties with judgement, impulsivity and tolerance may require careful management and the person may need a lot of support to maintain health and safety.
  • Confusion arising from cognitive impairment can cause unusual behaviour meal times e.g. eating dessert first, pouring custard on their main course, not using cutlery appropriately etc.
  • Even if the person is aware they have dysphagia, cognitive impairments may limit their ability to ‘resist’ food/drink that may harm them. It may be necessary to avoid leaving out food and drinks that the person may then impulsively try to consume.

When supporting people with dysphagia and cognitive impairment, it is important to maintain a safe environment (i.e. supervise and monitor the person’s access to food and fluids).  Cognitive impairments may increase the risk that the person tries to take food/fluid that is dangerous for them or adopts potentially dangerous styles of eating/drinking thus increasing the risk of choking and aspiration.

Communication Problems
Difficulties with language processing (dysphasia) or speech impairments (dysarthria/dyspraxia) may impair the person’s ability to communicate their symptoms of dysphagia to others.   The person with receptive dysphasia may not be able to understand the information given to them about dysphagia and what they need to do to help themselves.

Behavioural Difficulties
Behavioural Difficulties can affect safe eating and drinking.  It is important to be aware that agitation, verbal or physical aggression can all increase the risk of choking and aspiration. Maintaining a calm environment and trying to diffuse difficult situations will help reduce risk.  Behavioural difficulties may also impair the person’s ability to co-operate with assessment, the therapeutic process and to follow any recommendations made to support safe eating and drinking.

Medication
Many people with dysphagia are unable to take medication in tablet/capsule form. Alternatives such as medication in syrup, solution or orodispersible forms may need to be considered.  Advice may need to be sought from a Pharmacist if the person is unable to take tablets or requires medication to be delivered via an enteral feeding route.