Dysphagia. Seems like a funny word when you don’t know the definition of it. A person might not even come across this word unless their mother or father get diagnosed with dementia or Parkinson’s or if a loved one has a stroke or the SLP dreaded, aspiration pneumonia. Even a bad enough UTI can cause someone to have the symptoms of dysphagia! Dysphagia is, according to ASHA, defined as problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. That’s just a lot of words to tell you it means “difficulty swallowing”. It can be the scariest part of an SLP’s job, but in my opinion, it can be one of the most interesting.
An SLP can work with patients with dysphagia in a variety of settings. Either in a skilled nursing facility, hospital, long term care, and yes, even in schools. Prevalence of dysphagia is difficult to assess as it can be seen over many different diagnoses and diseases, but approximately 1 in 25 adults will experience a swallowing problem in the United States (Bhattacharyya, 2014).
In order to evaluate a patient with suspected dysphagia, an SLP may be looking for a number of signs or symptoms. A list found on the ASHA website is listed below:
Signs of dysphagia may include
An SLP may do what they call a “bedside evaluation” to determine if someone is safe to eat or if the diet should be changed. The SLP is looking for any of these signs. However, the best way to really see how someone is swallow is with a modified barium swallow (MBS) or videoflouroscopic swallowing study (VFSS). This is an X-ray of the swallowing function. The patient will take a couple bites or sips of barium coated food or drink and be asked to swallow as the X-ray is taken. It’s a quick and painless test, but it tells an SLP so much more than just a bedside evaluation.
The last thing I would like to mention about dysphagia that affects almost everyone with the diagnosis is the diet modification and treatment. I could write about this for pages, as this is something I do on an almost daily basis for the many clients at a facility that deserves it’s own blog post, but I won’t bore you with the details.. this time! Diet modification is what an SLP will suggest to a patient to keep them safe while eating. This might include thickening liquids or suggesting food to be ground down to a safe texture to make it easier for a patient to swallow. A lot of times family members and patients become frustrated with diet changes and rightfully so as it can be a hard pill to swallow (no pun intended). Other treatment may include swallowing exercises and positioning, thermal stimulation (use of ice and cold spoon to activate swallow function), and oral motor exercises for proprioception.
As an SLP, I do not take changing someone’s diet or suggesting they no longer eat, lightly. It is a life altering event and can be devastating to many people. Eating and food is not only a life necessity, but it’s also a social activity for many.
If you have concerns for yourself or a loved one, feel free to reach out to us for help!
Until next time,
Julie
An SLP can work with patients with dysphagia in a variety of settings. Either in a skilled nursing facility, hospital, long term care, and yes, even in schools. Prevalence of dysphagia is difficult to assess as it can be seen over many different diagnoses and diseases, but approximately 1 in 25 adults will experience a swallowing problem in the United States (Bhattacharyya, 2014).
In order to evaluate a patient with suspected dysphagia, an SLP may be looking for a number of signs or symptoms. A list found on the ASHA website is listed below:
Signs of dysphagia may include
- Drooling and poor oral management;
- Food or liquid remaining in the oral cavity after the swallow;
- Inability to maintain lip closure, leading to food and/or liquid
- Leaking from the oral cavity;
- Food and/or liquids leaking from the nasal cavity;
- Complaints of food "sticking";
- Globus sensation or complaints of a "fullness" in the neck;
- Complaints of pain when swallowing;
- Wet or gurgly sounding voice during or after eating or drinking;
- Coughing during or right after eating or drinking;
- Difficulty coordinating breathing and swallowing;
- Recurring aspiration pneumonia/respiratory infection and/or fever;
- Extra effort or time needed to chew or swallow;
- Changes in eating habits—specifically, avoidance of certain foods/drinks; and
- Weight loss or dehydration from not being able to eat enough.
An SLP may do what they call a “bedside evaluation” to determine if someone is safe to eat or if the diet should be changed. The SLP is looking for any of these signs. However, the best way to really see how someone is swallow is with a modified barium swallow (MBS) or videoflouroscopic swallowing study (VFSS). This is an X-ray of the swallowing function. The patient will take a couple bites or sips of barium coated food or drink and be asked to swallow as the X-ray is taken. It’s a quick and painless test, but it tells an SLP so much more than just a bedside evaluation.
The last thing I would like to mention about dysphagia that affects almost everyone with the diagnosis is the diet modification and treatment. I could write about this for pages, as this is something I do on an almost daily basis for the many clients at a facility that deserves it’s own blog post, but I won’t bore you with the details.. this time! Diet modification is what an SLP will suggest to a patient to keep them safe while eating. This might include thickening liquids or suggesting food to be ground down to a safe texture to make it easier for a patient to swallow. A lot of times family members and patients become frustrated with diet changes and rightfully so as it can be a hard pill to swallow (no pun intended). Other treatment may include swallowing exercises and positioning, thermal stimulation (use of ice and cold spoon to activate swallow function), and oral motor exercises for proprioception.
As an SLP, I do not take changing someone’s diet or suggesting they no longer eat, lightly. It is a life altering event and can be devastating to many people. Eating and food is not only a life necessity, but it’s also a social activity for many.
If you have concerns for yourself or a loved one, feel free to reach out to us for help!
Until next time,
Julie
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