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Swallowing disorders can be distressing: Imagine coughing every time you take a drink of water, or feeling like food is stuck in your throat each time you take a bite. Imagine being told it could be dangerous for you to eat or drink your favorite foods and beverages.
Dysphagia — or difficulty swallowing — can be caused by many conditions that affect the brain and nerves, such as a stroke, traumatic brain injury (TBI), spinal cord injury (SCI) or Guillain-Barré syndrome; progressive diseases including Parkinson’s disease and multiple sclerosis; and cancer- or surgery-related impairments with the head, neck, chest or mouth.
Dysphagia also can lead to weight loss, dehydration, poor nutrition, aspiration or reflux — or can result in social anxiety caused by not wanting to eat in front of other people.
Fortunately, swallow therapy is a solution for people with dysphagia. Through swallow therapy, patients learn exercises and strategies to improve safety, efficiency and comfort with swallowing — whether they have mild difficulty leading to occasional discomfort when eating or drinking or, in more severe cases, must relearn how to swallow, build strength and improve coordination to decrease dependence on feeding tubes.
Swallow Therapy & Speech-Language Pathologists
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In addition to evaluating and treating speech, language and communication disorders, speech-language pathologists (SLPs) also treat swallowing disorders in children and adults.
Kelly Rogers, MA, CCC-SLP, is a senior speech-language pathologist who specializes in treating patients with dysphagia in the Robert R. McCormick Foundation Think + Speak Lab at Shirley Ryan 小恩雅. She notes that those who specialize in treating swallowing disorders complete many years of additional hands-on training, mentoring and continuing education after completing a master’s program in speech-language pathology.
“In my specific role, I treat adolescents through adults with acquired swallowing impairments related to neurologic injury, neuromuscular diagnoses, progressive diseases, deconditioning related to complex medical events, transplant and heart conditions; head and neck cancer; and functional disorders,” said Kelly. “While many of the people I work with are experiencing new swallow difficulties, some have chronic difficulty with eating or drinking and are seeking ways to optimize function and quality of life.”
Getting Started in Swallow Therapy
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At the start of swallow therapy, an SLP will complete a comprehensive clinical evaluation — including an interview with the patient about symptoms and goals, as well as observe them eating or drinking a variety of textures. Oftentimes the SLP will recommend an exam to directly visualize the structures and function of swallowing. These can include videofluoroscopic swallow studies (VFSS), which capture X-ray video clips of patients swallowing food or liquid, or an endoscopic exam called a fiberoptic endoscopic exam of swallowing (FEES) which involves inserting an endoscope through a patient’s nose to visualize their throat.
“We use these assessments to generate an individualized treatment plan for each patient based on the specific nature of their problem,” said Kelly. “For some patients, this involves targeting the mouth or the throat muscles with therapy and focusing on strength, timing, coordination or a combination of swallowing skills.”
SLPs address specific impairments through strength-training exercises and skills-based practice that help patients learn — or relearn — how to use their muscles to chew and swallow. Devices may be incorporated into treatment sessions to improve tongue strength or cough strength, offer visual feedback on swallow effort and timing, or provide electrical stimulation to increase contraction of swallow muscles.
Patient Education & Swallowing Disorders
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In addition to helping patients make functional improvements in their swallowing, Kelly said that providing education to patients and families is extremely beneficial in addressing the anxiety and fear that can arise with dysphagia.
“Most people never think about swallowing, so patients can feel very out of control, helpless and afraid when their swallowing suddenly becomes a problem,” she said. “Eating and drinking is such a huge part of our social, emotional, cultural and religious lives. Professionals who treat dysphagia need to understand how devastating it can be for people who can't fully participate in eating and drinking activities.
“Some of my most rewarding sessions are when patients or families thank me for just spending the time helping them to understand their swallowing condition,” she added.
Recovering from Dysphagia
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Kelly said patients often ask her how long it takes for swallowing to improve, when they can return to eating certain favorite foods again, and when their feeding tubes can come out. Though there are a range of outcomes based on an individual’s condition, her feedback is encouraging.
“For some individuals, treatment focuses on strategies to improve their comfort or decrease the risk of developing respiratory infections related to food or liquid going down the wrong pipe, known as aspiration,” said Kelly.
For others, the direct result of swallow exercises is that patients make a full return to eating and drinking, even if they started rehabilitation with a feeding tube or were eating modified foods or liquids.
Some patients continue swallow therapy after they transition from inpatient rehabilitation to DayRehab or outpatient care. Or, SLPs may recommend a home exercise program so patients can keep working on swallow therapy at home.
“For many patients, we stress the importance of swallowing as a neuromuscular system and the importance of a ‘use it or lose it’ mindset. For some patients, the advice I give them is to ‘just keep eating,’” said Kelly.
