Dysphagia Awareness Month - Chloe, Speech Language Pathologist

June is Dysphagia Awareness Month. Dysphagia is the loss or impaired ability to chew and/or swallow that can be caused by neurological changes, structural issues and certain medical conditions.

We met with Chloe, a Speech Language Pathologist (SLP), to learn more about dysphagia, how it is diagnosed and what treatment may look like at our hospital for those with this disorder.

What is dysphagia and how can it affect a person’s life?

Dysphagia is the loss or impaired ability to chew and/or swallow. Swallowing is a complex and rapid process which involves many different muscles to trigger at the appropriate time and move together in a coordinated manner.

During normal swallowing, food or liquid travels from your mouth, through your throat, and into your esophagus, without entering into your airway or lungs. When swallowing is disordered, food and liquid can enter into the lungs, which is called aspiration.

Dysphagia can affect a person’s life as it can be a safety risk and lead to poor health outcomes such as poor nutrition or hydration, poor quality of life, fear of eating or drinking, social isolation, depression, choking, aspiration pneumonia, respiratory distress, and even death.

What causes dysphagia?

Dysphagia can be caused by neurological changes (e.g. stroke, acquired brain injury, Parkinson’s disease, dementia), structural issues (e.g. head and neck cancer, tracheostomy, etc.), and certain medical conditions (e.g. respiratory conditions like COPD or GI disorders). Swallowing is about timing and strength of the muscles of the mouth and throat, if there is weakness or incoordination of the muscles that are important for swallowing, this can lead to dysphagia.

As a Speech Language Pathologist (SLP) what do you do to help a patient through this diagnosis/recovery?

With regards to swallowing, we assess how a patient is able to move their structures that are important for chewing and swallowing and then we would trial various textures and consistencies of foods and fluids. We look for signs that could indicate aspiration such as, coughing, throat clearing, wet/gurgly voice, choking, etc.

Based on our assessment, we make recommendations to reduce the risk of aspiration. Recommendations may include introducing strategies like taking small sips, or one sip at a time, avoiding straws, or modifying the texture of the food or fluid if that appears safer. If a person is unsafe to swallow, they may require alternate means of nutrition.

If needed, we may conduct an instrumental assessment, which could involve an x-ray (videofluoroscopic swallow study) or a scope (nasopharyngeal endoscopy to assess swallowing or voice). These tests give an objective assessment of what is happening when the individual is swallowing. The results can help in making recommendations to implement strategies or maneuvers when swallowing or determining what exercises the patient can do to strengthen the swallowing muscles.

The SLP would continue to follow the individual to ensure they are tolerating their diet texture and determine whether they are appropriate to progress towards a regular diet texture.

Are there any outpatient programs a patient can participate in once they have been discharged?

Through the Home and Community Care Support Services/LHIN, we can request an SLP to continue ongoing assessment and management of a person who has dysphagia and who may continue to require diet texture modifications or compensatory strategies at the time of discharge. 

We can also make referrals for outpatient instrumental assessments of swallowing using either x-ray or scope, if needed.