Speech Connection, LLC





Dysphagia

DYSPHAGIA

Dysphagia = difficulty in swallowing.

Dysphagia occurs when a patient has difficulty swallowing food and liquids safely.   Dysphagia can evolve from a stroke, neurological, motility disorders, acid reflux, or pathological etiologies.

There are four phases of the swallow:

1. Oral preparatory phase
2. Oral phase
3. Pharyngeal phase
4. Esophageal phase

There are many types of dysphagia:

1. oral dysphagia
2. pharyngeal dysphagia
3. oropharyngeal dysphagia
4. esophageal dysphagia

Causes of dysphagia include:

  • Cerebrovascular Stroke
  • Multiple Sclerosis
  • Myasthenia gravis
  • Parkinson’s disease & Parkinsonism syndromes
  • Amyotrophic Lateral Sclerosis
  • Bell’s palsy
  • Bulbar Palsy & Pseudobulbar palsy
  • Xerostomia
  • Radiation
  • Neck malignancies
  • Eosinophilic esophagitis
  • Pharyngitis, etc.

Causes of esophageal dysphagia can be divided into mechanical and functional causes.

1. Functional causes include

a. achalasia,
b. myasthenia gravis, and
c. bulbar or pseudobulbar palsy.

2. Mechanical causes include

a. peptic esophagitis,
b. carcinoma of the esophagus or gastric cardia
c. external compression of the esophagus, such as obstruction by lymph node and left atrial dilatation in mitral stenosis.
d. Candida esophagitis,
e. pharyngeal pouch, aka Zenker’s Diverticulum
f. esophageal web,
g. esophageal leiomyoma,
h. systemic sclerosis
i. Barrett’s Esophagus

Various types of Dysphagia treatment provided are:
Vital Stim treatment (Neuromuscular Electrical Stimulation)-

This involves putting electrodes on either the neck or face or sometimes both to improve swallow function. Electrode placement is determined by the type of swallow deficit the client has through clinical observation and using results from the modified barium swallow study.

Thermal stimulation treatment- involves using lemon ice or lemon glycerin swabsticks, in the mouth, to stimulate the swallow efficiently and timely.

Compensatory strategies: Clients may use swallow strategies while eating to decrease or eliminate the risk for aspiration.

Some strategies may be a chin tuck, a head turn, double swallow, throat clear swallow, etc. The speech therapist will determine which strategies are more effective by clinical observation or by reviewing the modified barium swallow study.

Oral motor exercises or Beckman Oral Motor exercises: Your therapist may give you oral motor exercises to do to strengthen your oral musculature for improved oral preparatory skills, and improve swallow timing and initiation skills.

Pharyngeal Exercises- swallow exercises are done to improve swallow function in the pharynx (i.e. your throat). Swallowing muscles in your pharynx may be weak and need to be strengthened by exercising it. This can be done in conjunction with Neuromuscular Electrical Stimulation if it is not contraindicated due to certain medical conditions.

Meal and liquid trials: Your therapist may try different food and liquid consistencies to see how you tolerate it (i.e. without signs and symptoms of aspiration) using compensatory strategies and in conjunction with Neuromuscular Electrical Stimulation if appropriate.

Children and adults may have aversions to different textures and different food consistencies. Several food and liquid consistencies are trialed to eliminate these texture aversions.

Myofascial Release- Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion.

Specific soft tissue mobilization techniques are used to improve all stages of the swallow including; oropharyngeal, hypopharyngeal and pharygoesophageal phases.