By the American Speech-Language-Hearing Association & Nutrition411

Difficulty in swallowing can cause food to enter the airway, resulting in choking, pulmonary problems, inadequate nutrition and hydration, weight loss, and may even lead to death from causes like aspiration pneumonia. Swallowing difficulties are commonly found in over 6 million Americans. Causes include traumatic brain injury, stroke, central nervous system infection, head and neck cancer, and degenerative diseases in young and older adults.

How is Dysphagia Treated?

Treatment outcome studies have provided evidence that compensatory strategies designed to have an immediate effect on the swallow (i.e., postural changes or diet manipulation) can improve swallowing safety and efficiency. Postural techniques eliminated aspiration on thin liquids in 75 to 80% of dysphagic patients. Likewise, data are beginning to emerge that demonstrate the utility of pharyngeal muscle strengthening exercises for improving swallowing physiology.

Treatment approaches improve nutritional status and hydration, and reduce morbidity from pneumonia. The speech-language pathologist’s intervention in swallowing disorders helps contain medical costs by reducing the length of hospital stays, decreasing the need for non-oral feedings, reducing nutritional problems, and decreasing expenses associated with pneumonia and other pulmonary complications.

According to data collected from ASHA’s National Outcomes Measurement System (NOMS), the majority of adults treated for dysphagia in home-based settings made significant functional gains. The data reveal that approximately 60% of adults who required an alternative method of feeding (e.g., nasogastric tube, PEG) at the outset of treatment progressed to a level at the end of treatment where their swallow was safe and they no longer needed an alternative method of feeding.

Speech-language pathologists assess and treat patients with dysphagia. Assessments may include clinical bedside and/or instrumental methods such as videofluoroscopy or fiberoptic endoscopy (FEES). Studies of these assessment tools have found them to be highly sensitive in diagnosing dysphagia and guiding appropriate clinical decisions and treatments.

In some cases, dysphagia is treated with surgery or medication. In others, treatment might involve muscle exercises or using special eating techniques. Some patients must change the texture of the foods and fluids they eat to make swallowing easier. When dysphagia is severe, eating and drinking orally is not recommended. In these cases, providing nutrition via a feeding tube is recommended.

What Types of Fluid Modifications are Recommended for Dysphagia Treatment?

Sometimes when a person has dysphagia, it is necessary to thicken liquids to make swallowing them easier. Liquids are thickened to the consistency of honey, nectar (such as apricot nectar), or pudding. If thickened liquids are recommended, it is necessary to have every liquid consumed, including water, coffee, juices, and milk, of the recommended consistency.

How are Liquids Thickened?

Speech and language pathologists recommend using a commercial thickener, which is a powder that is mixed into beverages to thicken them. Many health care facilities purchase prethickened water, milk, coffee, and juice to take the guesswork out of thickening fluids. For home use, you can purchase thickening powder at drug stores.

What Types of Texture Modifications are Recommended for Foods?

The National Dysphagia Diet recommends three levels: dysphagia pureed, dysphagia mechanically altered, and dysphagia advanced.

Dysphagia pureed diet: Foods are pureed and homogenous, with all foods, including meats, vegetables, and breads, of pudding-like consistency.

Dysphagia mechanically altered diet: Foods that are moist, soft textured, and easily formed into a food bolus for swallowing are allowed. Foods are well cooked and soft. Meats are ground or minced.

The dysphagia advanced diet: Foods are of nearly regular texture, but very hard, sticky, or crunchy foods are not included.

A registered dietitian or speech-language pathologist can provide specific information about what foods are allowed on each diet.

Helpful Handouts:

Dysphagia: Scoop It, Mold It, Pipe It—Rice and Pasta

Dysphagia Level 1 Diet (dysphagia pureed)

Dysphagia Level 2 Diet (mechanically altered)

Dysphagia Level 3 Diet (dysphagia advanced)

—

Related Online Continuing Education Course:

Dysphagia: Guide to Establishing a Restorative Mealtime Program is a 2-hour online CE/CEU course that will enable therapists in long-term care or post-acute rehabilitation facilities to present staff training that offers strategies and techniques for implementing a Restorative Mealtime Program (RMP). The purposes of such a program are to make dining safe and enjoyable, to increase resident independence at mealtimes, and to create a mechanism for monitoring declining abilities as disease processes progress. Also included are descriptions of dysphagic indicators, lists of aspiration precautions, methods for ascertaining needed levels of assistance, case studies, and a method for monitoring adherence to swallow safety standards. The author includes useful forms, checklists, and diagrams with limited permission for course participants to reproduce handouts for their own use in daily practice. Course #20-26 | 2013 | 37 pages | 20 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for all programs and content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by theTexas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.