A stroke and/or traumatic brain injury can affect all aspects of communication and swallowing.

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There are 26 different muscles in the mouth, neck, throat, and esophagus that the brain controls when food or fluid is consumed. The nerves that control these muscles receive signals from the brain so they can work in a coordinated manner. When the brain has suffered an injury from head trauma, the signals to these 26 muscles may become uncoordinated.

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You might not think that a speech-language therapist can help someone who has difficulty swallowing. However, this type of therapy addresses a number of issues that often go together such as controlling the lips, tongue, and jaw, which are essential for both speech and swallowing.

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A swallowing therapist may start with an interview, then examine the mouth and then provide food and fluids at varying levels of thickness to determine how a person responds and if indicated an instrumental study can be completed.

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Functional MRI and PET scans of the brain show that swallowing is a complex process and that there are differences between swallowing on purpose versus swallowing by reflex when the back of the throat is triggered by fluid or a ball of food. Swallowing correctly isn’t limited to one specific area of the brain but involves numerous areas of the brain.

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Damage to the brain from head trauma and/or stroke and associated bleeding, swelling and nerve cell death can prevent the swallow signals from moving from the brain to the mouth and throat, and back again. This can also impact communication: linguistically, motorically or cognitively.

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The following terms are used to describe the complications that result from a brain injury or stroke:

• Dysphagia: difficulty swallowing

• Dysarthria: difficulty vocalizing speech

• Cognitive-Linguistic Impairments: memory, reasoning, temporal concepts, executive functioning

• Aphasia: loss of language, receptive and/or expressive

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Since it is essential to be able to speak, think, and swallow, anyone with difficulty in these areas needs to see a speech-language therapist. Specific testing can help determine the underlying problem behind losing one’s control over these essential functions.