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 Jiang Fang Shuai
Neurosurgery
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The difference between brainstem hemorrhage and cerebral hemorrhage.

Cerebral hemorrhage refers to any bleeding caused by the rupture of cerebral blood vessels. Based on the location of the bleeding, there is hemorrhage in the cerebral lobes, thalamic hemorrhage, cerebellar hemorrhage, brainstem hemorrhage, and so on. Consequently, brainstem hemorrhage is a type of cerebral hemorrhage. Because the brainstem is the life center of humans, even a small amount of bleeding can lead to severe consequences, and may even cause death. Therefore, brainstem hemorrhage is one of the most dangerous types of cerebral hemorrhage and has a very high rate of mortality and disability in clinical settings.

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Written by Jiang Fang Shuai
Neurosurgery
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Why would there be bleeding in the brainstem?

Firstly, hemorrhaging can occur anywhere there are blood vessels. The brainstem is an important functional area of the human brain, connecting the cerebrum above and the spinal cord below, with the cerebellum closely positioned behind it. It serves as a crucial relay station for neural connections. This area is the control center of human life, managing vital functions such as breathing and heartbeat. Additionally, this area is densely packed with blood vessels. For patients with chronic hypertension, unstable blood pressure control can lead to degeneration and necrosis of the vessels, and even the formation of dissecting aneurysms or microaneurysms, which can cause the vessels to rupture and bleed under certain conditions. Like the vessels in other parts of the intracranial space, the blood vessels in the brainstem can also bleed. This is referred to as brainstem hemorrhage.

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Written by Zhang Hui
Neurology
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Can brainstem hemorrhage be treated abroad?

Patients with brainstem hemorrhage mostly have a risk factor of long-term hypertension, and they usually have poor blood pressure control. This results in small artery lesions, and under emotional excitement or severe fluctuations in blood pressure, bleeding in the brainstem occurs. Brainstem hemorrhage is quite dangerous; many patients who suffer from a significant amount of bleeding in the brainstem can fall into a coma, and some, even if their lives are saved, might end up with paralysis of the limbs or in a vegetative state. Currently, this is a global challenge, and brainstem hemorrhage is generally not advised to be treated surgically. However, some top experts both domestically and internationally have attempted surgical treatment for brainstem hemorrhage, and a portion of patients may see some effects from it, but generally speaking, most hospitals do not advocate for surgical treatment of brainstem hemorrhage. The treatment protocols for brainstem hemorrhage do not vary significantly between countries; the international treatment plans are quite similar.

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Written by Zhang Hui
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Is brainstem hemorrhage prone to recurrence?

Brainstem hemorrhage is perilous, and its recurrence largely depends on the cause and the management of risk factors. For instance, one significant cause of brainstem hemorrhage is the presence of certain arterial-venous malformations and sponge-like angiomas. Such conditions tend to recur if not surgically addressed promptly by removing these abnormal vessels, thereby reducing the likelihood of recurrence. Additionally, hypertension is the most common cause of brainstem hemorrhage. Long-term high blood pressure can damage arterial walls and lead to ruptures and bleeding. Stable control of blood pressure, alongside a low-salt, low-fat diet, can prevent recurrence of brainstem hemorrhage. However, poorly controlled blood pressure, resulting in severe fluctuations, can significantly increase the risk of recurrence.

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Dietary Precautions for Brainstem Hemorrhage

For patients with brainstem hemorrhage, attention should be given to their diet. During the acute phase, it is advisable to choose a liquid diet, as most patients with brainstem hemorrhage often have severe swallowing dysfunction. Failing to choose a liquid diet can lead to aspiration, which in turn causes aspiration pneumonia. Furthermore, patients should avoid certain foods for a short period, particularly greasy or spicy foods, as most patients experience significant reductions in digestive function during the acute phase. If dietary intake is not carefully managed, patients often experience significant abdominal pain and diarrhea. Once the patient's condition stabilizes, it is appropriate to include fresh vegetables and fruits in their diet.