The challenges of managing dysphagia in brain-injured patients

Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.