1. Karen Jackman Specialist Speech & Language Therapist
DYSPHAGIA
Karen Jackman
Specialist Speech & Language Therapist

2. Overview Dysphagia definition Normal Swallow
Signs/Symptoms of Dysphagia
Role of SLT
Diet Consistencies, Thickeners
Treatment & Positioning

3. Dysphagia (dis-fay-juh)
Difficulty swallowing
Not a disease but a symptom of other disorders that may affect swallowing
Can be present in any 3 of the stages of swallowing

4. Oral Stage Oral preparation-Chew the food and mix with saliva
Oral stage – requires normal musculature and coordination with respiration
Lasts only seconds normally

5. Pharyngeal Phase Begins once the bolus passes tongue base
Sensory receptors send signal to brain to trigger swallow
Airway closed
Lasts 1 second or less

6. Video fluoroscopic Image of Pharyngeal stage of swallow

7. Oesophageal Stage
Takes place from the time the bolus enters the upper esophageal sphincter (UES/ cricopharyngeus) until it passes through the lower esophageal sphincter (LES)
Time varies from 8-20 seconds

8. Signs & Symptoms Dysphagia
Coughing before, during or after the swallow
Frequent coughing during or after a meal
Recurrent pneumonias
Weight loss
Wet, gurgly vocal quality
Temperature spikes
Increase in secretions
Patient complains of having difficulty
Logemann, 1998

9. Significance Pneumonia Malnutrition Dehydration Strokes
aspiration pneumonia rates highly correlated with morbidity rates (40%)
(Aviv, 2001)
Malnutrition
47% of patients with dysphagia experience
(Elmstahl, Bulow, Ekberg et al., 1999)
Dehydration
Strokes
45% prevalence

10. Role of SLT Assess Dysphagia Diagnose
Make appropriate diet and liquid recommendations
Treatment

11. Assessments done by SLT
Bedside Swallow Evaluation (BSE)
Videofluoroscopy
(Logemann, 1998)

12. Diagnosed by SLT Based on clinical signs/symptoms presented during BSE
SLT assesses stages of swallowing
Assess if dysphagia present and recommend diet/liquids

13. Diets & Thickened Liquids

14. Diet recommendations: food
Thin Puree
Cold Soft smooth
Puree
Soft Fork Mashable (no bread)
Normal Diet (softer options)
Normal diet

15. Thickened Liquids Naturally Thick Tomato Juice Stage 1 Syrup like
Yoghurt like
Stage 3
Thick custard

16. Treatment by SLT Swallow Maneuvers Exercises Diet Modifications
Alternative Feedings
Patient & Family Education
Exercises
Diet Modifications
Sensory Stimulation
Electrical Stimulation
Compensatory Strategies/Postural Techniques
Ertekin, Keskin, Kiylioglu et al
2001

17. MOUTH CARE!
Oral infections are a major contributing factor in chest infections.
Don’t forget mouth care, especially if they are NBM.

18. REFERRALS
Referrals for SALT can be made by any qualified member of staff and must be written (ideally, first two pages of the SAP) and then phoned through to extension 1417 or faxed to
Appropriate-Is the patient conscious and well enough to be assessed?

19. References
Aviv, J. (2001). Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEEST). Retrieved September 24, 2003, from eMedicine.com.
Elmstahl, S., Bulow, M., Ekberg, O., Petersson, M. & Tegner, H. (1999). Treatment of Dysphagia Improves Nutritional Conditions in Stroke Patients. Dysphagia 14:
Ertekin, C., Keskin, A., Kiylioglu, N., Kirazli, Y., Yagiz, O.A., Tarlaci, S & Aydogdu, I. (2001). The Effect of Head and Neck Positions on Oropharyngeal Swallowing: A Clinical and Electrophysiologic Study. Archives of Physical Medicine and Rehabilitation 82.
Logemann, J.A. (1998). Evaluation and Treatment of Swallowing Disorders. Austin: Pro-Ed.
Palmer, J.B., Drennan, J.C. & Baba, M. (2000). Evaluation and Treatment of Swallowing Impairments. American Family Physician.
Speiker, M.R. (2000). Evaluating Dysphagia. American Family Physician.

20. Questions