DYSPHAGIA (SWALLOWING DIFFICULTIES)

Swallowing and eating, as we know, is not only important to our survival as human beings but also to our sense of connection, social identity and social involvement with others.


You may have never thought about how complex swallowing is or how important it is to your daily interactions with others until now, when you are experiencing difficulties and/or discomfort with eating. Difficulties with eating including difficulties in the oral cavity (mouth), pharynx, esophagus (tube in which transfers food into stomach) and/or gastroesophageal junction (the location where food enters the stomach) is known as dysphagia and can be a result of several different medical conditions, including structural changes or differences in your body, stroke, traumatic brain injury or a neurological condition.  You may be experiencing one or several of the following symptoms:

 

  • Difficulty keeping food or liquid in your mouth, food leaks out of the mouth due to poor lip closure

  • Difficulty managing the food in your oral cavity and drooling

  • A feeling that food is “sticking” somewhere in your mouth or throat

  • A sensation of a lump in your throat or fullness in your neck

  • Pain when swallowing

  • Coughing either during or immediately after eating or drinking

  • Food or liquid coming out of the nasal cavity

  • You take an extended length of time and effort to chew or swallow

  • Difficulty breathing when swallowing (coordination of breathing and swallow may be impaired)

  • A change in your voice quality to wet or gurgly sounding during or after eating or drinking,

  • Frequent visits to your doctor or local hospital for recurrent fever, or respiratory infection or aspiration pneumonia

  • Avoidance eating foods that you once enjoyed 

  • Loss of weight or appetite


You may also experience a loss of interest in eating and overall enjoyment with eating or drinking due to either embarrassment or feelings as though others are noticing your difficulties/differences when eating.


What does an assessment look like?

 

Non-Instrumental Assessment: In order to assess your swallowing difficulties, I will watch for any signs and symptoms of dysphagia while you are eating while also taking into consideration other factors that may be influencing your swallowing difficulties such as fatigue when eating, how you are positioned when eating, and other environmental conditions.  Speech and vocal quality before, during and after the swallow will also be noted, as well as changes in heart rate, facial appearance and physiological status. 

 

Case History: Detailed gathering of information regarding your medical conditions/records, including consultation with your caregivers and other health professionals involved.

 

Oral Mechanism Exam: You will be asked to move your mouth in different ways, including your jaw, lips and tongue where your strength, tone, overall range of motion and ability to coordinate movement will be observed. In addition, I will look at the structure of your face, inside your mouth and the structure of your lips, tongue and jaw. I may also conduct a cranial nerve assessment to determine whether there is an underlying neurological impairment.

Compensatory strategies and/or changes to food delivery will also be assessed to determine whether certain strategies or changes to food either worsen or improve the swallowing. Following the non-instrumental assessment or the “Bedside Swallowing Assessment”, you may be referred for a swallow study to further investigate the nature of your swallowing impairment or difficulties. 


What does therapy look like?

 

The most important goal for swallowing intervention is to ensure that you are able to safely and efficiently manage both solids and liquids in order to support hydration and nutrition. Often consultation with your doctor(s) and other health practitioners (e.g. Occupational therapist, GI specialist, Dietician) is also critical in moving forward as it will help to guide treatment decisions such as diet modifications, the use of compensatory strategies and/or exercises. Dysphagia therapy can involve compensatory strategies that change the swallow when they are used (these do not have a long term effect), exercises that may improve certain functions of the swallow and changes to diet consistency. 

 
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11 Meadow Heights Drive, Bracebridge, Ontario, Canada

aspirespeech.muskoka@gmail.com

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