I had a stroke two years ago and STILL can't swallow – help!
OUR resident specialist and NHS GP, Dr Zoe Williams, shares her expert advice.
Today, Dr Zoe helps a reader who is suffering from total dysphagia and wants to know which treatments are available.
2
Q) FOLLOWING a stroke two years ago at the age of 69, I have total dysphagia and have been peg tube fed since.
Everything else is back to normal except the ability to swallow but despite doing all the exercises, given by the Speech and Language Therapy team, nothing has worked.
Neuromuscular electrical stimulation therapy is private and expensive. Is there any other treatment available?
A) Dysphagia is the inability to swallow, which is why you have been fed via a tube into the stomach.
I'm sorry to hear that you haven't seen improvement despite support from SALT.
NMES aims to retrain the nerves and muscles, and SALT exercises increase effectiveness. But it lacks sufficient robust evidence at the moment to be rolled out.
However, it can be used as part of clinical trials or audits. A newer NHS-supported treatment, pharyngeal electrical stimulation, targets the throat's pharynx region. It aims to 'rewire' nerve pathways.
Clinical trials (eg, the PHADER study) show it improves swallowing safety and reduces aspiration risk in stroke patients. The NHS is also currently investigating transcranial magnetic stimulation (TMS) aimed to reactivate swallowing centres in the brain.
Other therapies include Botox if muscle stiffness is an issue and surgery to dilate the oesophagus. Do request a multidisciplinary reassessment (neurologist and SALT) to explore your options.
And do ask about NHS trials.
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