Home Rehabilitation When Chewing Becomes Difficult: How One Stroke Survivor Regained the Ability to Chew
Written by: 増田 翼 (Registered Nurse)
Eating involves two functions: chewing and swallowing. You may have noticed, in yourself or in someone you care for, that “I’ve started choking lately” or “it’s become harder to swallow my food.”
As we age, we become more prone to illnesses such as cerebrovascular disease, dementia and Parkinson’s disease. Muscle strength also declines with age, which can make it harder to eat well.
If swallowing has become difficult, exercises to strengthen the throat are needed. However, eating can also feel harder to swallow when the step before it, chewing, has weakened. Food left in the mouth, food spilling from the lips, slurred speech: when you see signs like these, the ability to chew may have declined.
Chewing is teamwork between the teeth and the mouth
Chewing food is called mastication. It does more than break food into an easy-to-eat form with the teeth; it also mixes food with saliva so that it is easier to swallow.
Chewing is not simply moving the jaw up and down. It is a complex movement that uses the tongue and the insides of the cheeks to chew efficiently. And while chewing, the lips must stay firmly closed so that food doesn’t spill out.
If we compare chewing to mochitsuki, the traditional Japanese way of pounding rice cakes, it is like the partnership between the person who pounds the rice with a mallet (the teeth) and the person who turns the rice in time with each strike (the lips, tongue, cheeks and saliva). If the mallet comes down at the wrong moment, it hits the turner’s hand; and no matter how long you pound, the rice will never become smooth if no one turns it.
Case study: B, who could no longer chew after a stroke
B had been unable to eat properly because of the aftereffects of a cerebral infarction (stroke) and often choked during meals. The hospital that discharged B had said, “Eating by mouth will be difficult, so nutrition will be given through a tube in the nose. Jelly is fine as an occasional treat.”
When I visited B’s home as a visiting nurse and observed how B swallowed, there was little phlegm, and B could swallow the saliva in their mouth without any problem. What’s more, B still had all 28 of their own teeth, and they were well aligned.
However, the stroke had left the muscles around B’s mouth paralyzed, and B could not chew food properly. If food that has not been chewed well enters the throat in a form that is hard to swallow, it can cause aspiration, where food goes into the windpipe.
Even so, both B and the family wanted B to “eat real meals,” so in consultation with the doctor and the dentist, we started chewing training.
Chewing exercises you can do at home
I asked B to practice the following exercises on their own as chewing training:
To close the lips firmly, repeatedly say “eee” and “ooo,” and press a straw flat with the lips
To move the tongue, stick it out and lick the lips
To chew better, chew dried squid (surume)
Thanks in part to this training, B learned to chew food well. Three months after discharge, the nasal tube was removed, and B now eats the same meals as the rest of the family.
Everyday conversation is also training for chewing
Exercises for chewing well are easy to do at home and can also help prevent the loss of muscle strength that comes with aging. Doing lip exercises like B’s “eee” and “ooo” before meals makes an efficient warm-up.
Talking with friends and family is also very important for maintaining the ability to chew, because using your voice moves the muscles around your mouth a great deal.
Older people living alone has become an issue in recent years. Spending time alone means having no one to talk to and fewer chances to move the mouth, which affects the ability to chew. Chatting as much as you can, laughing often and moving your mouth are all good practice for chewing well.
B also attended a day service (adult day care) three times a week under Japan’s long-term care insurance. Chatting with the people there was an important opportunity for B to regain chewing strength.
Adjust meal textures step by step to match chewing ability
While it is important to regain lost function through training, it is just as important to adapt the texture of meals to the person’s ability to chew. As B gradually learned to chew better through rehabilitation, we moved B’s meals little by little closer to regular food.
Still, “moving little by little closer to regular food” is difficult without a guide. In such cases, use the classifications of Smile Care Food, defined by Japan’s Ministry of Agriculture, Forestry and Fisheries, or Universal Design Food (UDF), defined by the Japan Care Food Conference.
In B’s case, the family first prepared foods in the UDF category “no chewing needed,” then moved on to “can be crushed with the tongue” and “can be crushed with the gums,” then to “easy to chew,” and finally, step by step, to the same meals as the rest of the family.
Don’t forget dental treatment and denture adjustments
I have explained that keeping the cheek and tongue muscles strong is important for chewing, but of course the teeth matter too. If dentures don’t fit, consult a dental clinic early. If the person mainly uses a wheelchair and finds it hard to get to a clinic, home-visit dental services can come to the home, so please make use of them.
Enjoying the texture of food is a very important part of enjoying meals, and texture is something you sense by chewing well. To keep not only the teeth but also the muscles around the mouth strong, value conversation with friends and family. If you ever feel that chewing has become difficult, consult a medical professional and try adding mouth and tongue exercises to your routine.
About the author: 増田 翼 (Registered Nurse)
This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us
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