After-Effects of Stroke and Eating Rehabilitation: Support That Can Continue at Home

Written by: 増田 翼 (Registered Nurse)

What are the after-effects of cerebrovascular disease?

Many illnesses can cause eating difficulties, but diseases of the nerves and muscles in particular make it hard to eat by mouth.

Cerebrovascular disease (stroke) occurs when blood vessels in the brain become blocked or burst, and it can leave paralysis of the limbs and difficulties with speaking and understanding speech. Many people also lose the sensation of needing to urinate, become incontinent and need diapers. And when the disease affects the parts of the brain responsible for eating, problems appear such as being unable to chew or swallow properly, or coughing when swallowing.

Typical cerebrovascular diseases include cerebral infarction (ischemic stroke), in which a blood vessel in the brain is blocked, and cerebral hemorrhage and subarachnoid hemorrhage, in which a vessel bursts and bleeds. The brain can also be injured by a strong impact, such as in a traffic accident, leaving lasting after-effects.

However, not everyone who has a stroke develops eating problems. And some people who have severe after-effects right after onset gradually improve.

When someone has a cerebral infarction or similar stroke, they are usually taken by ambulance to a hospital that can provide specialized treatment. There, the doctor explains, “A blood vessel in your brain is blocked. It’s a cerebral infarction.” But that alone doesn’t tell you whether eating problems will occur.

So which strokes are likely to cause eating problems? It depends on whether the stroke affects a “specific part” of the brain or another part.

What happens when a stroke occurs in the medulla?

First, let me explain this “specific part.”

The brain has a region called the medulla oblongata. The medulla is the lowest part of the brain, and besides eating, it plays roles that are vital to life, such as regulating breathing and heart rhythm.

Some people die when a stroke strikes this region, but if the stroke is mild, the person can survive.

Even so, after-effects may remain in eating, an activity essential to our lives. Other symptoms include dizziness, a hoarse voice and unsteadiness, but many people have relatively little paralysis of the body.

Case 1: A, who did rehabilitation at a specialist rehabilitation hospital

A had a cerebral infarction in the medulla. Once A’s condition had stabilized, A was transferred from the hospital A had been rushed to by ambulance to a specialist rehabilitation hospital.

In the first swallowing test, A could not even get jelly down and coughed when drinking tea.

After continuing treatment as an inpatient at the rehabilitation hospital, A was eventually able to eat croquettes made by A’s wife and walked home on discharge.

A regained the pleasure of eating through rehabilitation in hospital, but most rehabilitation hospitals set a guideline for the length of stay. Even when that period ends and the person is discharged home, however, specialized rehabilitation can continue through long-term care insurance.

Case 2: B, who went home with a gastrostomy tube

B also developed eating problems after a cerebral infarction in the medulla.

B loved drinking with friends, but sadly was unable to eat by mouth while in hospital and returned home with a gastrostomy (PEG) tube.

B was certified at Care Level 5, the highest level of care need, and at home uses home-visit nursing twice a week, home-visit rehabilitation three times a week and home-visit dental care twice a month. At home, rehabilitation was provided by physical therapists and speech-language-hearing therapists, and nurses also carried out rehabilitation while managing B’s health.

With a home-visit dentist involved, endoscopic examinations can be done even at home to check whether food is being swallowed safely. Six months after discharge, B was able to eat yogurt. B hasn’t yet reached the point of drinking the alcohol B loves, but continues rehabilitation to this day.

When a stroke occurs outside the medulla

Eating problems caused by strokes in parts of the brain other than the medulla are said, as a rule, to occur with a second or later stroke. So they are unlikely to occur with a first stroke.

A person who previously had a stroke but fortunately had few after-effects and was living at home without problems may develop severe eating problems after a second stroke.

Paralysis may also affect both arms and both legs. Problems with the act of eating can also appear, such as being unable to concentrate on meals or to use chopsticks or a spoon.

Case 3: C, who could no longer eat after a second stroke

C had a cerebral infarction 10 years ago but fortunately had no after-effects and was living at home. After a second cerebral infarction, however, symptoms such as being unable to swallow food and coughing appeared. Unable to eat by mouth, C had a gastrostomy tube placed and resumed life at home.

Like B, C used home-visit nursing and home-visit dental care through long-term care insurance, and improved to the point of being able to eat pureed meals. C now lives with hardly any use of the gastrostomy tube.

Don’t give up: start by talking to your care manager

As described above, eating problems caused by stroke fall broadly into two types, and for people aged 40 and over, both are covered by Japan’s long-term care insurance.

Even people who were told in hospital that they could not eat by mouth may become able to do so as they continue care at home.

However, not every home-visit nursing station or home-visit dental practice focuses on rehabilitation. And the amount of services available is capped (the benefit limit), depending on the person’s care level. That is exactly why you should talk to your care manager first.

If your care manager finds you a home-visit nursing station or home-visit dentist with strong rehabilitation expertise, you should be able to live at home with the goal of eating by mouth.

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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.

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