Swallowing Evaluation and Therapy Procedures
What is dysphagia?
Swallowing disorders, also called dysphagia (dis FAY juh), can occur at different stages in the swallowing process:
- Oral phase: sucking, chewing and moving food or liquid into the throat
- Pharyngeal phase: triggering of the swallowing reflex, moving food and liquid through the throat, and protecting the airway from food or liquid entering the trachea or lungs to prevent choking or aspiration
- Esophageal phase: relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach
Speech-language pathologists evaluate, diagnose and treat swallowing disorders in the oral-pharyngeal phases.
Some causes of oral-pharyngeal swallowing problems in adults are:
- Brain injury
- Spinal cord injury
- Parkinson’s disease
- Multiple sclerosis
- Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
- Problems affecting the head and neck, such as cancer in the mouth or throat; injury or surgery involving the head and neck; decayed or missing teeth; or poorly fitting dentures
Some causes of oral-pharyngeal swallowing problems in children are:
- Nervous system disorders (cerebral palsy, meningitis, encephalopathy)
- Gastrointestinal conditions
- Prematurity/low birth weight
- Heart disease
- Cleft lip or palate
- Respiratory disease
Many other diseases, conditions or surgical interventions can result in oral-pharyngeal swallowing problems. General signs may include:
- Coughing during or right after eating or drinking
- Wet or “gurgly” sounding voice during or after eating or drinking
- Extra effort or time needed to chew or swallow
- Food or liquid leaking from the mouth or getting stuck in the mouth
- Recurring pneumonia or chest congestion after eating
- Weight loss or dehydration from not being able to eat enough
As a result, individuals may have:
- Poor nutrition or dehydration
- Risk of aspiration (food or liquid entering the airway) which can lead to pneumonia and chronic lung disease
- Less enjoyment of eating or drinking
- Social isolation
For help, consult your doctor about the possible medical cause of the swallowing problem. An ASHA-certified speech-language pathologist can perform an evaluation of feeding and oral-pharyngeal swallowing and provide treatment if appropriate. Many medical specialists and other healthcare professionals may work together to evaluate and treat feeding and swallowing problems.
How does a speech-language pathologist evaluate oral-pharyngeal dysphagia?
Clinical/bedside swallowing evaluation: This evaluation is performed in the outpatient clinic office or bedside if the patient is in the hospital. The speech-language pathologist will take a careful history of medical conditions and symptoms; look at the strength and movement of the muscles involved in swallowing; and observe the patient while eating to assess posture, behavior and oral movements while eating and drinking. The speech-language pathologist may recommend additional, special tests to evaluate the patient’s swallow in more detail.
Videofluoroscopy: This study is performed in the radiology department with a speech-language pathologist and radiologist present. A motion-picture X-ray is recorded as the patient swallows a set of liquids and solids of varied consistencies. The structure and physiology of the oral and pharyngeal stages of the swallow are assessed. The esophagus is scanned when possible to follow passage of the bolus. With this study, the speech-language pathologist and radiologist assess the patient’s airway protection/cough response and can determine if aspiration is present. The speech-language pathologist will also evaluate whether any strategies will improve swallowing function and if the patient may be a candidate for therapy to improve swallowing function.
Fiberoptic endoscopic evaluation of swallow (FEES): This evaluation is performed in the outpatient clinic office or bedside if the patient is in the hospital. A small, fiber optic endoscope is inserted in the nose of the patient and the oral-pharynx and larynx are visualized and recorded as the patient swallows a set of liquids and solids of various consistencies. No medication or radiation is used. This study can be performed throughout a meal if needed. The speech-language pathologist is able to assess penetration/aspiration, airway protection/cough response, timing of the swallow, and the amount and clearance of residue from the throat. The speech-language pathologist can also try different strategies and evaluate if they will improve swallowing function and if the patient may be a candidate for therapy to improve swallowing function.
What treatments are available for dysphagia?
Treatment varies depending on the cause, symptoms and type of swallowing problem. A speech-language pathologist may recommend exercises, positions or strategies to help swallow more effectively, as well as specific food and liquid textures that are easier and safer to swallow.
Therapy techniques available at UHS include:
- Traditional dysphagia therapy: Dependent upon the patient’s type of dysphagia, this may include oral-motor-swallowing exercises, thermal (cold) stimulation, voice exercises, education, training in use of compensations, and keeping a journal of daily food and liquid intake.
- Deep pharyngeal neuromuscular swallowing therapy: In this therapy technique, a set of thermal stimulation procedures are performed to elicit automatic neuromuscular responses from the patient to strengthen and coordinate swallow function. Therapy is done several times a week.
- Neuromuscular electrical stimulation (Vital-Stim): With this technique, a set of electrodes are placed on the patient’s face and neck to elicit muscle contractions. Swallowing exercises and actual eating/drinking are performed during neuromuscular electrical stimulation to increase swallow strength, coordination and timing. Therapy is generally performed for 45 to 60 minutes three to five times a week for several weeks. For further information go to www.vitalstim.com.
- EMG: With this biofeedback procedure, a set of electrodes is placed on the patient’s neck. The patient’s swallow is visualized by a graph on a computer screen or on a number value on a handheld unit. The patient works to improve strength and timing of muscle contractions during swallows.
- Pediatric swallowing/feeding therapy: Feeding and swallowing behaviors in children from birth through childhood are evaluated and treated through a developmental approach and may include oral stimulation, exercise, compensations, parental education, use of special equipment or behavioral management techniques to increase swallow safety and efficiency and to increase the child’s overall intake and variety of food textures tolerated.
Please note: The speech-language pathology services available at UHS Delaware Valley Hospital and UHS Chenango Memorial Hospital differ from those provided by UHS Physical Therapy and Rehabilitation in Johnson City and Binghamton; please contact those locations for details on the services they provide.