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Dysphagia

What is dysphagia?

Causes of dysphagia

Consequences of dysphagia

Signs to look out for

The role of the SLP in dysphagia

General feeding rules

Food consistencies

Thickening fluids

Frequently asked questions

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What is dysphagia?
 
Dysphagia is the medical term for a swallowing disorder. Difficulties may occur while chewing or swallowing as well as while drinking in all age groups.
Dysphagia can occur at various phases in the swallowing process. Initially difficulties can occur whilst chewing and moving food or liquid around the mouth, due to weak tongue or cheek muscles. Later on during the swallowing process difficulties may be related to the actual triggering of the swallow, the total closure of the airway during the swallow and / or the opening of the upper muscle of the oesophagus. Finally, difficulties may occur in squeezing food through the oesophagus towards the stomach.
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Causes of dysphagia include...


Damage to the nervous system that may affect the coordination of the swallowing muscles or limit sensation in the mouth and throat. These include stroke, brain & spinal cord injury, Parkinson’s disease, cerebral palsy and dementia.

Problems effecting the head & neck as cancer of the mouth or throat, injury to head & neck.

Dental and oral hygiene problems as decayed or missing teeth poorly fitting dentures, dry mouth.

Other causes as surgical interventions, longstays in intensive care units.

Many other diseases, conditions, or surgical interventions, including older persons who are very unwell and weak, as well as, patients following long term stays in Intensive Care / Therapy Units.

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Consequences of dysphagia

  • Poor nutrition, weight loss & dehydration;
  • Risk of food/liquid entering airway leading to chest infections;
  • Less enjoyment of eating & drinking and;
  • Embarrassment or isolation in social situations involving eating.



 

Signs to look out for...

  • Anxiety while eating & avoidance of food items
  • Changes in taste
  • Food/fluid leaking from mouth
  • Prolonged time while chewing
  • Coughing/choking while eating or drinking
  • Lack of sensation of food remaining in mouth
  • Wet/Gurgly voice
  • Sensation of food stuck in throat
  • Dry mouth
  • Heartburn after eating
  • Recurrent chest infections
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The role of the SLP in dysphagia

 
The SLP has a very important role with patients suffering from dysphagia. At an acute hospital set up, the patient is assessed through an orofacial assessment. A full dysphagia assessment on different diet consistencies is also carried out. Initial compensatory techniques are used to ensure safe swallowing. When indicated, patients are also referred for objective assessment as videoflouroscopy or FEES.
 
Speech Language Practioner assisting a patient 
In a rehabilitation set up, the SLP continues the intervention process through a number of therapeutic exercises and rehabilitation techniques. SLPs in community clinics continue with the intervention process also within the patients' home environment. Liaison with the rest of the interdisciplinary team as well as with the patient's carers/relatives is considered by the SLP as crucial to achieve comprehensive assessment, continuation of therapy as well as to provide holistic and person centred care.



 

General feeding rules

  • Good posture, sitting comfortably with back against chair and head upright;
  • Calm down and relax during feeding;
  • Avoid distractions;
  • Slow down rate of intake;
  • Ensure your mouth is clear of any food particles;
  • Remain seated for 15-20 minutes after eating.
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Food consistencies



 Liquidised  Carrot SoupFruit PureeMilk products
  • Use potato, cornflour or thickening agents to thicken.
  • Use milk, gravy or juices to loosen.

 

  
 Mashed  Mashed Food
  • Food should be easily mashed with a fork.
  • Overcook if necessary.

 

 Soft  PastaVegetable burgers
  • Make sure food is very soft.
  • Overcook if necessary.

 

 Regular  SoupBread RollAppleCoffee
  • No changes in food consistency are required


Your SLP will recommend the appropriate consistency.

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Thickening fluids

 
It may be safer to thicken fluids due to your swallowing difficulties. Follow the recommendations given by your SLP when using thickening agents to achieve the required consistency.

Helpful hints
  • Put liquid in glass;
  • Add thickener using scoop according to recommended quantity;
  • Mix with a small fork or whisk;
  • Leave drink to stand for 60 seconds.  
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Frequently asked questions

 

Will I be able to eat / drink?
The swallow can improve. Sometimes there will be good enough recovery to go back to eating a normal diet. In other cases there may be less recovery but certain foods may still be eaten. If a progressive neurological condition is present, normal swallowing may be unlikely. However, treatment at various stages will ensure safe swallowing for as long as is possible. It is important to follow the Speech Language Pathologist’s guidelines.


Can I still dine out and socialise?
You should still be able to socialise while enjoying a meal or drink with family or friends. It is advisable to go through the menu and select food items that are of the recommended consistency or texture. If necessary request for food to be overcooked. Food thickener can be easily carried in small/pocket sized containers, ready to be used if thickened fluids are recommended.


What can I do if food does not taste the same as it did before?
The nerves that stimulate taste buds in your tongue might have been affected. Your SLP can give you a number of exercises that can help you with this difficulty.


What can I do if I am having difficulties to swallow my medication?
Taking medications can be a challenge for a person with dysphagia. Problems may occur when swallowing thin fluids, lumps or tablets. Your pharmacist can help you with medications that can be taken in syrup form; these can be thickened to your swallowing needs. Some medications can be crushed and taken with thickened fluids, yoghurts or custard. Always consult your pharmacist to check if this is possible. If none of the above can be done, discuss any changes in medication with your doctor.


Where can I get help?
A certified Speech Language Pathologist can perform a swallowing evaluation and provide treatment when appropriate. A team of healthcare professionals may be involved in your care. Support from family and friends is also very important.