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 the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
• 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.

Some causes of swallowing problems in adults are:

• Stroke
• 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 and decayed or missing teeth, or poorly fitting dentures.

Some causes of 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 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 swallowing and provide treatment if appropriate.  Many medical specialists and other health care professionals may work together to evaluate and/or treat feeding and swallowing problems.

How does a speech-language pathologist evaluate 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, will look at the strength and movement of the muscles involved in swallowing and will 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 Radiology 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 are able to assess the patient’s airway protection/cough response and can determine if aspiration is present.  The speech-language pathologist will also assess to see if 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 fiberoptic 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 assess 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 greatly 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, and/or specific food and liquid textures that are easier and safer to swallow

Therapy techniques available at UHSH 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 techinique 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/or 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 done for 45-60 minutes 3-5 times a week for several weeks.  For further information go to www.vitalstim.com.

EMG: This is a biofeedback procedure whereby 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 and/or behavioral management techniques to increase swallow safety and efficiency and to increase the child’s overall intake and variety of food textures tolerated.

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