Hillel Finestone and Linda Greene-Finestone1 offer many useful points in their article on dysphagia. However, it is disappointing that the technique and value of swallowing retraining2,3 are not mentioned.
Credit for recognizing that stroke victims may “forget” how to swallow, and can be retrained to do so, goes to Henry Heimlich.4,5 Both of his papers are well worth reading, as they document the pioneering of a new therapy. In brief, the technique of swallowing retraining is based on the idea that the reflex sequence of deglutition can be retaught if it is lost as a result of stroke. Heimlich's original reports4,5 described patients being instructed in sucking, elevation of the larynx and coordination of those functions. People who have lost the ability to swallow for other reasons, such as disuse atrophy of the pharyngeal muscles, can also be retrained.
Over a period of years this mode of rehabilitation gradually became the domain of speech pathologists, and many physicians who care for stroke patients have unfortunately remained completely unaware of it. If there is swallowing dysfunction but no speech impediment, it is quite possible that a speech pathologist will not be consulted, and the patient may be unnecessarily consigned to permanent gastrostomy. As described in the article,1 swallowing function returns spontaneously in some cases. In others, it does not — but in some of those patients, it can be restored by retraining.
Fred Saibil Division of Gastroenterology Sunnybrook and Women's College Health Sciences Centre University of Toronto Toronto, Ont.
References
- 1.Finestone HM, Greene-Finestone LS. Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. CMAJ 2003;169(10):1041-4. [PMC free article] [PubMed]
- 2.Saibil FG. Swallowing retraining for transfer dysphagia [abstract]. Gastroenterology 1988;94: A394.
- 3.Saibil FG. Restoration of swallowing in patients with transfer dysphagia [poster]. Royal College of Physicians and Surgeons of Canada annual meeting; 1988 Sep; Ottawa.
- 4.Heimlich HJ, O'Connor TW. Relearning the swallowing process. Ann Otol Rhinol Laryngol 1979;88(Pt 1):794-7. [DOI] [PubMed]
- 5.Heimlich HJ. Rehabilitation of swallowing after stroke. Ann Otol Rhinol Laryngol 1983;92(Pt 1): 357-9. [DOI] [PubMed]