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Scott Fraser: a timely answer to a devastating problem

“Will I ever be able to eat normally again and to enjoy meals at home with my wife and son?”

For more than two years while hospitalized after a traumatic brain injury that left him unable to swallow, this question consumed Scott Fraser’s thoughts. The answer came in an unexpected way: his wife Lorraine stumbled upon it in a copy of Toronto Rehab’s +8 Report on Rehabilitation Research that she found in a lounge a few doors down from her husband’s hospital room at a Toronto area hospital.

A story about a man with a similar swallowing problem led the couple to Dr. Catriona Steele, director of Toronto Rehab’s Swallowing Rehabilitation Research Laboratory. Fraser enrolled in a research study, being conducted by Dr. Steele, to test a new swallowing therapy involving tongue-pressure exercises. He was more than willing to give it a try. His swallowing problems – a condition called dysphagia – were devastating. “It was very, very depressing,” he says of the time he was unable to drink liquids and eat regular, solid food.

It all began in November 2007 when Fraser’s family was involved in a car crash with an impaired driver. Fraser was left with many challenges, including dysphagia. Tube feeding directly into his stomach deprived him of the taste, texture and social aspects of eating, but it kept him alive and nourished.

Eventually, he graduated to drinking thickened liquids and eating puréed foods by mouth but he didn’t like the taste and texture. Every meal was a painfully slow process. Fraser had to swallow twice for each mouthful of food and wash it down with a sip of thickened liquid. To prevent food and liquid from going down his airway and to his lungs, which can cause pneumonia, he had to tuck his chin to his chest every time he swallowed.

In the Toronto Rehab study, Fraser learned a series of tongue-pressure exercises using his tongue to squeeze a bulb positioned in his mouth. In 24 sessions, he mastered the exercises that Dr. Steele calls “boot camp for the tongue,” regained his swallow and moved a giant step closer to being able to go home from hospital.

Dysphagia often occurs with conditions such as brain injury, stroke, Parkinson’s disease and multiple sclerosis. It also increases as people age (up to 80 per cent of people in nursing homes have swallowing problems). A major contributor is a loss of muscle strength in the head, neck and especially the tongue, which is composed entirely of muscle.

“We want to be able to train these muscles so that a person’s swallowing improves without needing to think about it every time they swallow,” says Dr. Steele.

“After a brain injury, there’s enough to worry about,” says Lorraine Fraser. “My husband has had to learn to walk again, his quality of speech has been affected and he has some cognitive challenges. So to have his swallowing resolved is a huge thing. Dr. Steele has no idea how our quality of life has improved. Her research has helped our family tremendously.”

In the summer of 2010, after two-and-a-half years in hospital and treatment at Toronto Rehab, where he participated in the study, Fraser was discharged home. Every day, he enjoys meals with his family. He can safely drink liquids and eat the most challenging food including meat, popcorn and nuts.

“I have the same food as Lorraine and my son Kyle, and I can eat my meal in half an hour. I enjoy these times with my family. It’s very important to me.”