Dysphagia: What It Is and How A Speech-Language Pathologist Can Help


By Susan Becker, Speech Therapist






What is Dysphagia?

Simply put, Dysphagia is difficulty in swallowing or the inability to swallow. Dysphagia may be present with the following conditions:

  • Stroke
  • Certain types of Cancer
  • Respiratory difficulties (tracheostomy, COPD, Asthma)
  • Neuromuscular disorders such as Parkinson’s disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, and more.

There are different phases of swallowing:

  • Oral Phase: involves food entering the mouth and being manipulated by the oral structures (lip, tongue and palate) and then transferred to the back of the mouth in preparation for
  • Pharyngeal Phase: involves the actual initiation of the swallow and the passing of food/liquid down through the
  • Esophageal Phase: where food enters the esophagus and travels through the esophagus into the

The Types of Dysphagia

Oral Dysphagia is when a person has difficulty preparing and manipulating food/liquids in preparation for swallowing due to reduced tongue, lip or palate ROM and weakness.

Pharyngeal Dysphagia is when a person has difficulty swallowing food or liquid through the pharynx leading to residual food and /or aspiration of the food/liquid.

Aspiration is when food/liquid has entered the airway (trachea) and continues on to enter the lungs either before, during or after the initiation of a swallow. This can lead to aspiration pneumonia.

The signs and symptoms of Dysphagia

There are several signs and symptoms of dysphagia, including:

  1. Coughing or choking during or after eating
  2. Throat clearing during or after eating
  3. Watery eyes when eating
  4. Changes in vocal quality (wet or gurgly voice)
  5. Weight Loss
  6. Multiple swallows
  7. Excessive time to swallow
  8. Complaints of food \”getting stuck” in the throat
  9. Difficulty chewing or breaking down solids
  10. Gagging
  11. Drooling and/or decreased ability to keep liquids or solids in the mouth
  12. Pocketing of food in the mouth
  13. Fever
  14. Frequent pneumonia

How a Speech Language Pathologist helps people with Dysphagia

A Speech Language Pathologist (SLP) would conduct an in depth swallow evaluation and determine the least restrictive diet. They will also determine if therapy and additional testing is indicated. Additional tests conducted by an SLP may include a Modified Barium Swallow (MBS) study or Fiberoptic Endoscopic Evaluation of Swallowing (FEES). These tests can accurately assess penetration or aspiration of food/liquids into the lungs, swallowing integrity, and determine a course of action.

In the LTACH setting, an MD will refer a patient to the SLP when he/she is medically stable, including respiratory status, to be considered for oral nourishment. Not everyone will be able to have the opportunity to eat in this setting and patients are considered on an individual basis.        \’

Following an evaluation by the SLP, a treatment plan will be developed. This plan may include diet modifications for solids, thickening liquids, oral, laryngeal, and pharyngeal exercises, and various swallow strategies.

At the LTACH, we have various food and liquid consistencies that may be recommended when a patient is considered for oral nourishment depending on the type and severity of the dysphagia.

Solid Consistency:

  • Puree
  • Ground
  • Fine Chopped
  • Chopped
  • Regular

Liquid Consistency:

  • Pudding Thick
  • Honey Thick
  • Nectar Thick
  • Thin Liquids

Safe swallow strategies and guidelines are developed for each individual. These may include, but are not limited to:

  • Body positioning
  • Head positioning
  • Single sips and bites
  • Alternating liquids
  • Repeat swallows

The SLP will work with each individual patient, teaching compensations, completing oral, laryngeal and pharyngeal exercises and educating them on their dysphagia. Our goal is for each patient with is considered for PO nourishment to be able to have the least restrictive diet and get back to enjoying this pleasure in life.

LTACH’s provide the services of a licensed Speech Language Pathologist. At Specialty Hospital of Central Jersey, the Speech Language Pathologist cares for patients at an LTACH setting typically three times per week. To contact us, click here.

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