MSSANT Network Autumn 15 WEB

Safety during meals
Michelle Searle
Swallowing impairment, or dysphagia as it is known
medically, occurs in about one third of people with multiple
sclerosis. These problems can have a negative impact
on the person’s safety and enjoyment during meals.
Swallowing difficulties in multiple sclerosis are caused
by demyelination of the brainstem which interrupts nerve
impulses to the muscles involved in swallowing. This may
impact on the strength, range or rate of muscle movements.
As well as interrupted muscle activation, sensory changes
can affect the person’s ability to trigger a swallow. These
problems not only confound a person’s safety leading to
distress, but can also lead to considerable embarrassment
and social withdrawal.
As 31 pairs of muscles are involved in the swallowing
process, a person may continue to swallow relatively
normally with considerable denervation of muscles involved.
When swallowing is affected however, it can have
significant impact on safety during meals. Difficulties can be
experienced during any of the three phases of swallowing:
oral, pharyngeal or oesophageal. Firstly, there may be
difficulty chewing food or problems in moving food around
the mouth. When getting ready to swallow, it can be hard to
move food to the back of the mouth. Triggering the swallow
may be delayed or effortful, and may result in coughing.
Food may also remain in the mouth after the swallow.
As food travels down the throat, the person may find that
some of it sticks to the walls and is hard to clear. Sips of
water can help to dislodge these particles. If the valve at the
bottom of the stomach is not working properly, food may be
regurgitated or reflux symptoms may result.
It is important to remember that these symptoms, like
any other multiple sclerosis symptoms, can get worse or
improve after a short time. In addition, fatigue may increase
symptoms later in the day. Stress, pain, depression and
cognitive changes can place a person at further risk of
swallowing related problems.
Long term risks of swallowing problems may include
malnutrition, dehydration, suffocation, choking and
pneumonia, which can be life threatening or result in a
lengthy recovery process. People at greatest risk are those
who are dependent on feeding, oral care, have a number of
different disorders, have a compromised immune system or
are on a number of different medications.
As a result of this significant risk, prevention is a priority of
any management plan. Working with a speech pathologist
and other health care professionals to develop a swallowing
regime can significantly reduce the risks associated with
dysphagia. This process involves assessments to determine
the best strategies to maintain safe swallowing. They are
designed to support a person’s independence and promote
personal management of swallowing issues.
If a person’s swallowing difficulties progress further, they
may not be able to manage normal food or drink safely.
In this case, the speech pathologist may recommend a
modified diet or thickened fluids. These will help the muscles
involved in swallowing to safely transfer food and drink into
the stomach, therefore protecting the lungs. By learning to
modify diets, a person can maximise safety, maintain health
and maximise enjoyment during mealtimes.
In a small number of cases, swallowing can become too
dangerous and a PEG feeding tube may be recommended.
This allows liquid meals to be fed directly into the stomach.
Some safe swallow strategies include:
• eating whilst sitting in a 90 degrees upright position and
remaining in that position for 30 minutes after your meal;
• taking small bites and mouthfuls, and chewing food
thoroughly;
• eating in a quiet environment free from distractions, i.e.
turning off the TV and avoiding talking;
• tucking your chin slightly downward toward your chest on
the swallow;
• drinking plenty of water throughout the day;
• adding extra sauce and gravy to your meals to help
transport food safely into the throat; and
• checking inside your mouth after your meal to make
sure no food is remaining.
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Autumn 2015 The MS Society of South Australia & Northern Territory