Returning to normal

Therapists help patients re-learn functions such as swallowing

Katherine Loupe, of Port Allen, has come a long way in her recovery from the stroke she had last summer.

She’s back in her own home with her husband, R.J. Loupe, and steadily getting her strength back.

As part of her recovery, she is working toward a full return of her capacity to swallow safely.

“I have to be careful to chew my food really good before I swallow,” Katherine Loupe, 74, said.

Immediately after her stroke, Loupe was unable to eat by mouth, said Brittany Durand, a speech pathologist with Amedisys Home Health who was at the Loupes’ home recently to provide special therapy that strengthens swallowing.

While it’s something people take for granted, swallowing is more complex than one might think.

Take the process of drinking water.

“You don’t think about it, but the water passes over your lips, you hold it into a ball (in your mouth) and it goes over the back of your tongue,” said Mary Casper, a speech pathologist in Rockville, Md., and a volunteer leader with the American Speech-Language and Hearing Association.

Swallowing also is the one time when a person reflexively stops breathing, said David Hutchings, of Nashville, Tenn., managing director of rehab services for Baton Rouge-based Amedisys.

That aspect makes it an especially important issue for patients with chronic obstructive pulmonary disease, a lung disease that makes it hard to breathe, Hutchings said.

“When I found out the truth about it (the mechanics of swallowing),” said Loupe’s husband, “it made me a little more scared about it. We still put thickening (product) in the liquids” that Katherine drinks.

Speech pathologists often work with people who have difficulty swallowing, a condition called dysphagia. It can be caused by several medical reasons, such as multiple sclerosis, Parkinson’s disease, stroke and dementia.

It’s not a natural part of aging, but most people with dysphagia are elderly, Hutchings said.

Difficulty swallowing can lead to aspiration of food or liquids into the lungs, upper-respiratory infection or pneumonia and weight loss, he said. It’s often hard for the patient or others to know aspiration is happening, he said.

“It’s referred to as ‘silent aspiration,’ ” Casper said.

In healthy people, the reflexive reaction to food or drink is to cough, she said. But certain neurological conditions may result in such reduced sensations that a person may aspirate and not even know it, Casper said.

Instead, Hutchings said, they may demonstrate other symptoms like watery eyes or a runny nose.

“Look for it if they have allergic-type symptoms every time they eat,” he said.

“I find patients on all kinds of allergy medicine, but it’s not addressing the main problem,” Hutchings said.

In some cases, treatment will be exercises that work to protect the airway, focusing on the patient’s Adam’s apple, which goes up and down when a person swallows, to close the airway, he said.

“By taking the Adam’s apple ‘to the gym,’’ the higher it goes, the easier it gets to swallow safely,” Hutchings said.

Last year, the Amedisys speech-language program helped patients meet nearly 71 percent of their treatment goals, compared with the national average of nearly 52 percent, as given in a National Outcomes Measurement System report by the America Speech-Language and Hearing Association.

“It’s crucial to help patients recover the ability to swallow,” said Hutchings, a licensed geriatric speech and language pathologist, in a news release from Amedisys.

After her stroke in August 2011, Katherine Loupe spent time in the hospital, then in a rehabilitation facility and a skilled-nursing facility, before going home in February this year.

“We were so excited,” her husband said. One of their sons built an outdoor wheelchair ramp for his mother.

She’s been able to get off the feeding tube for nourishment; it’s only used for her to receive medicine, in the form of crushed pills, said R. J. Loupe, who’s a council member-at-large for the Port Allen City Council.

The Loupes have a big family. They raised 10 children all together, seven of their own and three other related children, R.J. Loupe said.

They have 20 grandchildren and 12 great-grandchildren. The Loupes’ children help their parents on weekends and drop in during the week, too, R.J. said.

The Loupes also have the help of an independent caregiver, Brenda Harrison.

The family has learned a lot about how to help Katherine recover.

She doesn’t use straws to drink, because people tend to swallow in big gulps that way, R.J. Loupe said.

He mashes up the food she eats, too.

“I chew real well,” Katherine Loupe added.

“She’s a salad eater,” but he’s still scared of lettuce for her, R.J. Loupe said.

“I find when I eat a lot of something, I need a drink handy to wash some of the food down,” Katherine Loupe said.

Durand, the speech pathologist, visits the Loupes’ home twice a week to help Katherine with exercises, and Katherine practices them on her own, too.

“Brittany has been a huge asset to us,” R.J. Loupe said.

On a recent day, Durand and Katherine Loupe started on one exercise by making a singing sound, starting at a high note, then going to a low note.

“It helps with the flexibility of the voice box, so it’s safer when you swallow,” Durand said.

Next, together, they pronounced the syllable “kee” over and over again.

“It helps strengthen the base of the tongue. The back of the tongue is very important. It helps the food shoot down the throat,” Durand said.

The most difficult exercise of the day involved putting the tip of the tongue between the teeth and trying to swallow. It’s hard to do and also strengthens the base of the tongue, Durand said.

Durand and Loupe went through a number of exercises. Even puckering and giving a kiss is an exercise “that’s good for lip control and keeping the liquids in the mouth,” Durand said.

Katherine Loupe looked at her husband nearby and said, “He’s been amazing, he really has.”

“All that is, is love. I love you,” R.J. Loupe said.

“I love you, too,” she said.

Sara Mele, a speech pathologist with Amedisys, who was also there that day, said, “I’ve been in this for over 20 years, and this is one thing that makes a big difference: family support.”