How to exercise swallowing after a brainstem hemorrhage

Written by Tang Ying
Physical Medicine and Rehabilitation
Updated on September 28, 2024
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Patients with brainstem hemorrhage often have critical conditions. Therefore, after stabilizing their condition, their swallowing function is usually severely impaired. During swallowing training, besides the common use of medications and acupuncture treatment, professional swallowing therapists in a formal rehabilitation medicine department conduct training on swallowing functions. Before starting swallowing training, an accurate assessment of swallowing function is typically conducted first. Swallowing disorders are divided into four stages: the preparatory stage, the oral stage, the pharyngeal stage, and the esophageal stage. In the preparatory stage, coordinating the consistency of the food can aid the patient's swallowing. Proper stimulation of the oral and pharyngeal muscles, including stimulation of the tongue and pharyngeal wall muscles, cold therapy, tongue pressure training, and training of the muscles around the mouth, are used to help restore swallowing function. During the esophageal stage, when the patient's condition has stabilized, videofluoroscopic swallow study can be carried out to assess specific issues in the esophageal stage, which are often related to cricopharyngeal dysfunction. Esophageal dilation with a balloon may also be used. With these accurate assessments and appropriate training, the swallowing function of patients generally shows significant improvement. Therefore, when patients experience these swallowing dysfunctions, it is best to seek treatment from a formal rehabilitation medicine department for better care.

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Written by Zhang Hui
Neurology
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What will happen with brainstem hemorrhage?

Brainstem hemorrhage is a very dangerous disease because the structure of the brainstem is so crucial. It contains the life centers responsible for breathing and heartbeat, as well as sensory and motor nerve fibers passing through it. If the brainstem hemorrhage is severe and the amount of bleeding is large, the patient may experience paralysis of the limbs, swallowing dysfunction, and choking on water, among other symptoms. If the condition worsens, it can lead to coma, persistent high fever, and even death. Patients with minor brainstem hemorrhages may exhibit symptoms such as dizziness, nausea, vomiting, numbness in the limbs, and paralysis. Generally, brainstem hemorrhages are caused by hypertension, which must be well controlled.

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Written by Zhang Hui
Neurology
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How to rescue brainstem hemorrhage?

Brainstem hemorrhage is an extremely dangerous disease. Patients typically have a long history of hypertension, and their blood pressure is not particularly well-controlled. The onset of the condition is sudden, and if the bleeding is extensive, it can quickly lead to unconsciousness and even respiratory and cardiac failure, resulting in death. It is crucial to rush the patient to the nearest hospital for emergency treatment to avoid aggravating the brainstem hemorrhage due to bumps during a long transport. Generally, the patient should be kept in a supine position, and if they are still conscious, it is vital to keep their emotions stable. Additionally, it is necessary to ensure the airway remains clear. If respiratory failure occurs, ventilation can be provided. Medications that reduce intracranial pressure can be administered to alleviate brainstem edema. Furthermore, respiratory stimulant drugs can be given to ensure breathing. Overall, the mortality rate for brainstem hemorrhages is exceedingly high, with a lack of particularly effective emergency measures.

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Written by Gao Yi Shen
Neurosurgery
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How long does it take to wake up from a coma caused by brainstem hemorrhage?

The timing of awakening after a coma caused by a brainstem hemorrhage must be judged based on the situation. As brainstem hemorrhages are relatively severe, there is generally no possibility of awakening if the patient's breathing, heartbeat, and circulation are not stable. If the patient can breathe normally off a ventilator and has a normal heartbeat and other vital signs, and pupil responses are also normal, then typically, they may awaken within one to two weeks. However, recovery times vary from person to person depending on the specifics of the condition, the location of the hemorrhage, and the surrounding tissue involved. Therefore, assessments should be made based on specific clinical signs at the time. Particularly with hemorrhages in the medulla oblongata, once coma ensues, it's often impossible to fully awaken the patient, and many succumb to complications later on. Therefore, adequate psychological preparation is essential in clinical settings.

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Written by Chen Yu Fei
Neurosurgery
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The critical period for brainstem hemorrhage is several days.

For patients with brainstem hemorrhage, the first week after the onset is a critical period. During this time, the bleeding may gradually increase, and secondary cerebral edema may occur, leading to dysfunction of the brainstem and even respiratory and circulatory failure, which can endanger the patient's life. Therefore, for these patients, it is crucial to closely monitor any changes in their condition, transfer them to the intensive care unit, and closely monitor their vital signs. Special attention should be paid to the patient's blood pressure, respiration, heart rate, pupil reactions, consciousness, and limb activity. Dynamic follow-up head CT scans should be performed to observe any changes in the condition.

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Written by Gao Yi Shen
Neurosurgery
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What causes brainstem hemorrhage?

In clinical practice, the main factor causing brainstem hemorrhage is hypertension. Some secondary factors include diabetes, hyperlipidemia, smoking, drinking, and other unhealthy lifestyle habits. These factors combined can more easily lead to brainstem hemorrhage. Among them, hypertension has the most significant impact. Continuous rise or fluctuation of blood pressure can easily cause vascular fluctuations, especially damaging the inner lining of the vessels and leading to arteriosclerosis. The brainstem is supplied by the basilar artery, and the pontine arteries branch vertically from the brainstem. When blood pressure rises, it seldom reduces the impact on the vessels and can directly cause the vessels to rupture, resulting in bleeding in the brainstem, which is the primary cause. Therefore, it is crucial to strictly control blood pressure in patients with brainstem hemorrhage to reduce the likelihood of recurrence later.