Swallowing Difficulties, Dysphagia
(Pronounced dis-fay-jer. Not to be confused with dysphasia which is to do with loss of language skills following an acquired brain injury)
The term dysphagia covers not only swallowing difficulties but also control of all the complex movements needed to cope with eating and drinking. Feeding difficulties and problems with swallowing can be a feature of many different conditions, and affect both children and adults.
The risks arising from lack of appropriate dysphagia management may occur with either group:
- respiratory infections
- choking
- weight loss and/or dehydration because of poor nutrition/fluid intake
- a reduced quality of life
- family anxiety and distress
Some of the following may occur (depending on the person's age and medical condition):
- Signs of distress at meal times and food refusal.
- Coughing and/or choking on food or fluid before, during, or after swallowing.
- Change in facial expression, or eyes filling with tears.
- Change in respiratory pattern associated with choking/coughing (e.g. breathlessness, rapid breathing rate, change of colour).
- Inability to eat all types of food, or slow eating and swallowing.
- Having food in the mouth but not doing anything to manage it.
- Loss of food from the mouth; spitting out food or fluids.
- Reported feeling of food 'sticking in the throat'.
- Reported pain on swallowing.
- Inability to manage saliva.
- Inability to manage usual medication such as pills.
- Wet, 'gurgly' voice quality.
Speech and language therapists are often involved with a multi-disciplinary team working with swallowing difficulties. The team may include doctors, physiotherapists, occupational therapists, and dieticians, together with specialists from ENT, gastro-enterology, and X-ray departments. A speech and language therapist's assessment may include observation at meal times.
The following may form part of therapy input for people with swallowing difficulties:
- Exercises for the lips, tongue, etc.
- Trials with different food and fluid consistencies.
- Advice on compensatory strategies (e.g. seating position, posture, modifying texture, changing feeding technique).
- Sensory enhancement/stimulation.
- Advice on any onward referral to another department for further investigation (e.g. x-ray).
- Advice regarding whether feeding by mouth is safe or not.
- Reassessment and review of swallowing function.
- Advice to parents or carers.
Some points you may wish to discuss with any therapist you contact:
- The therapist's specialist credentials in the area of swallowing difficulties (e.g. extra training, work experience in relevant hospital departments).
- Which client group(s) the therapist has worked with where swallowing difficulties were a problem, and how much relevant experience the therapist has.
- Does the therapist carry out further investigations such as videofluoroscopy (MBS - modified barium swallow).
- Is the therapist able to refer to other professions (e.g. ENT, gastro-enterology).
- Where the therapist sees clients for assessment/therapy.
- How much the therapist charges for assessment and/or regular therapy.
Click here to search for Speech Therapists in your area with Swallowing / Dysphagia as a specialty.