
Swallowing Problems (Dysphagia): Signs, Complications, and Treatment
By Kathryn Wamstad, M.S., CCC-SLP
Did you know that speech therapists treat more than just your speech? They do indeed! In fact, one of the primary focuses of a Speech Language Pathologist in the geriatric setting is swallow therapy. Speech therapists treat swallowing difficulty because the same muscles and nerves used for talking are used for chewing and swallowing.
Swallowing difficulty is called dysphagia. It can occur because of a stroke, brain injury, cancer, neurological disease like Parkinson’s and Alzheimer’s, surgery involving the neck, and other aging related complications. Dysphagia can lead to reduced quality of life with eating/drinking, malnutrition, dehydration, and pneumonia as a result of aspiration. Aspiration is when food or drink is accidently inhaled down into the airway/ lungs.
What Are Symptoms of Dysphagia?
- Facial droop, drooling, losing food and liquid out of the mouth and lips
- Difficulty chewing and controlling the food and liquids from the front to the back of the mouth, and food left in the mouth after you swallow
- Throat clearing, coughing or choking right after a bite or drink
- Feeling food or drink “go down the wrong tube” or get stuck in your throat
- Wet/gurgly voice quality, watery eyes, and runny nose while eating
- Feeling like food is stuck in your chest, sensation that food takes a while to go down, heart burn, or food coming back up (regurgitation)
- Weight loss, malnutrition or dehydration because of difficulty eating, extra time and effort required to eat, and frequent occurrences of aspiration pneumonia
Assessment of Dysphagia
Speech therapists assess swallowing difficulty by asking questions and observing you eat and drink to see if the above symptoms are noted. If symptoms of swallowing difficulty are reported or observed, it is recommended that you participate in a Video Fluoroscopic Swallow Study. This is an x-ray video of the swallow that allows us to see how the internal structures of your throat are working to determine the cause of your swallowing difficulty, for creation of a treatment plan.
Treatment of Dysphagia
Swallowing difficulty can be treated through multiple modes of therapy including participation in personalized exercise program engagement, being trained on use of safe swallowing compensatory strategies, and/ or implementation of a diet change.
Exercise Engagement
Strengthening the muscles of your mouth and throat can help improve your swallow function. A Video Fluoroscopic Swallow Study determines what muscles have weaknesses and need to be targeted with exercise engagement. Based on your specific muscle weakness, your speech therapist will recommend exercises such as the Effortful Swallow, The Mendelsohn Manuever, and Chin Tuck Against Resistance. There are also respiratory exercises to strengthen your lungs so that you have a stronger cough to more effectively clear aspiration.
Safe Swallowing Compensatory Strategies
Receiving training on safe swallowing compensatory strategies is a standard practice in swallow therapy. Adherence to general safe swallowing strategies like sitting upright, eating slowly, taking small bites and drinks is beneficial; however, completion of a Video Fluoroscopic Swallow Study can best determine if more specialized compensatory strategies like use of a double swallow, volitional cough or a chin tuck are required to reduce risk of aspiration when eating and drinking.
Diet Change
Changing the texture of food and the thickness of drinks is another common practice in speech therapy. Softer foods are easier to chew and swallow, and thickened liquids move slower and are easier to control from the mouth to the throat. A Video Fluoroscopic Swallow Study and speech therapist observation at a mealtime can aid in determination of what foods and liquids are safest and easiest for you to consume. Speech therapists follow the International Dysphagia Diet Standardization Initiative (IDDSI). IDDSI is a global framework that describes and defines the level of foods and liquids for those with dysphagia. See below for the IDDSI food and drink levels, https://www.iddsi.org/standards/framework.
Kathryn Wamstad is a speech language pathologist for Ascend Rehab at Saint Therese of Woodbury. She has been with Ascend for nearly five years and also provides outpatient and home health services for Ascend sites at Village Shores, Parkshore, Summit Place, Global Point, and The Orchards of Minnetonka.
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