Swallowing

We've all experienced difficulty with our swallowing. Perhaps our timing was off and "something went down the wrong way". Or we tried to swallow a piece of food that was too big and had trouble getting it down. Our bodies are equipped to manage an occasional episode of food not swallowed effectively. However, when people experience consistent episodes or the situation becomes health threatening that is called dysphagia.

What is Dysphagia?
Dysphagia (dis - FAH - juh) is the medical terminology for difficulty when swallowing. This could mean difficulty in the actual act of swallowing or pain associated with swallowing.

What are the symptoms of Dysphagia?
There are many observable indicators of a swallowing disorder. These include:

A patient may also present with other dysphagia warning signs that are not specifically related to a stage of swallowing including: watery eyes, facial reddening, struggling behaviors, facial grimmancing, frequent fevers and/or upper respiratory infections.

• Acute damage to the brain or peripheral nervous system such as a stroke or traumatic brain injury
• Chronic brain disorders or neuromuscular disease such as Dementia or Parkinson's Disease
• Cariopulmonary diseases such as emphysema or congestive heart failure
• Surgery or radiation treatment

• Aspiration occurs when food or drink passes below the vocal cords and into the trachea (wind pipe). Repeated aspirations that are not effectively cleared (coughed up or cleaned out by the lungs) can accumulate in the lungs and cause aspiration pneumonia. Many patients are not diagnosed with dysphagia until they enter the hospital with pneumonia.
• Dehydration and malnutrition can occur if people avoid certain foods or liquids that are difficult to swallow or if they have anxiety or negative experiences associated with meals.

What should I do if I think a loved one or I have Dysphagia?
It is important to let your doctor know immediately. Your doctor can refer you to a local Speech-Language Pathologist (SLP) who is trained to evaluate your swallowing and determine if meal modifications and swallowing treatment are appropriate.

What happens during Dyphagia Therapy?
Once you've been diagnosed with dysphagia, a speech therapist will determine if it is appropriate to begin a rehabilitation program. Dysphagia Rehabilitation occurs in the hospital, in a private clinic, on an outpatient basis, and in nursing homes.

Dysphagia therapy addresses both rehabilitation and compensation. Rehabilitation is aimed at having a patient return to the most normal functioning as possible. Rehabilitation includes active and passive exercises that must be completed daily, and food/liquid trials to determine if a patient is ready to upgrade their diet. Compensation is focused on using strategies and modifications to maximize patient safety and quality of life without attempting to "improve" swallowing function. Examples of compensation include: adjusting a patient to a special diet, postural techniques and attempts at specific swallowing maneuvers.

How can I prevent Dysphagia?
For many patients, the swallowing difficulty they experience is out of their control. However, it is important for everyone to follow standard aspiration precautions when eating and drinking to prevent aspiration. A list of standard aspiration precautions is listed below:

• Position yourself fully upright (90 degrees) for all eating and drinking
• Remain upright for at least 15 min. after meals
• Control the size of your bites of food and sip of liquids
• Take medications one pill at a time
• Carefully and adequately chew all your foods
• Avoid talking with food in your mouth / while swallowing
• Avoid eating two hours before bedtime
• Avoid spicy / acidic foods before bedtime
• Take all prescribed medications regularly (to avoid worsening conditions that cause dysphagia)