SWALLOWING AND FEEDING:

Dysphagia, or swallowing disorders, can exist in people of all ages. There are two stages in the swallowing process: Oral (biting, chewing and beginning to swallow foods) and Pharyngeal (passage of the food or liquid through the throat, or "pharynx"). When a patient is diagnosed with dysphagia, it can be due to difficulties in one, or both, of these phases. If a patient is demonstrating difficulty with the pharyngeal phase, they are at a high risk for pneumonia, weight loss and decreased health. Difficulty swallowing may often be diagnosed at bedside by a trained individual, but videoflouroscopic (video x-rays showing the patient swallowing) studies are typically completed to assess the pharyngeal phase.

Signs of dysphagia include, but are not limited to, loss of food through the lips, weight loss, pocketing of food in the cheeks and coughing while swallowing foods. The elderly can be diagnosed with dysphagia after a stroke or due to degeneration of the muscles used to swallow because of aging, Parkinson's disease or Alzheimer's disease.

Other adults may require swallowing therapy after a traumatic brain injury, an aneurysm or due to degenerative medical conditions. Therapy for these individuals focuses on helping the patient bite, chew, and initiate the swallow sequence, and on strengthening specific sets of mouth and throat muscles.

Infants may be diagnosed with swallowing deficits due to premature or difficult birth or having a medical diagnosis which may result in swallowing problems, like cerebral palsy. Pediatric dysphagia therapy focuses on two areas:

•  Oral-Motor and Pharyngeal Strengthening Therapy - Focuses on oral-facial exercises to strengthen muscles, biting and chewing training, and pharyngeal (throat) strengthening exercises.

   

• Sensory Therapy - Focuses on helping children who will not eat due to sensory issues, such as dislike for food texture.

Individuals with dysphagia may require a special diet or alternative methods of feeding. Special diets include pureeing foods, providing soft foods, adding extra moisture or adding thickener to liquids to make their consistency thicker. While many patients complain about the diet changes, they are necessary to ensure their safety while swallowing and their health. Occasionally alternative methods of feeding may be recommended such as through a naso-gastric (nose) tube or PEG (stomach) tube. Alternative feeding methods are discussed between the family and their physician. A decision to use any of these alternative feeding methods is not necessarily a final choice; it can often be reversed with therapy as the patient becomes stronger and more alert.

Additional Links:

Dysphagia Resource Center

Dysphagiaonline.com

Carolina Pediatric Dysphagia