Eating, drinking and swallowing difficulties (Dysphagia).

Eating, drinking and swallowing difficulties (Dysphagia).

Speech and Language Therapists assess, diagnose and treat swallowing difficulties as part of a multidisciplinary team, including the person themselves, and their family or carers

Swallowing disorders, known as dysphagia (pronounced dis-fay-dya) affects a person’s ability to safely swallow drinks, food and medication. It can impact people across the lifespan. Swallowing disorders can have a significant impact on health and on quality of life. Occasionally you may also hear the term FEDS this stands for Feeding, Eating, Drinking and Swallowing.

Speech and Language Therapists may have many roles and responsibilities in the management of dysphagia such as clinician, researcher, team manager and educator. The IASLT has developed a number of clinical guidelines for members to support their practice in this clinical area. This can be found in the learning centre and members' area.

The ability to eat, drink, and swallow safely requires motor, sensory, and cognitive skills. These can be affected across the lifespan

What causes swallowing difficulties?

The ability to eat, drink, and swallow safely requires motor, sensory, and cognitive skills. These can be affected across the lifespan.

The ability to eat, drink, and swallow safely requires motor, sensory, and cognitive skills. These can be affected across the lifespan. It can involve the pre-oral stage, before the food reaches the mouth (involving the pace of eating and drinking). It can be the oral phase: this is the ability to contain the food or drinks in the mouth, chew and manipulate the food with the tongue, propel it backwards toward the throat to the pharyngeal phase: this involves the propulsion of the foods and drinks from the mouth to the oesophagus, typically the larynx or voice box moves forward, the epiglottis closes over the airway and prevents the food entering into the lungs (aspiration), weakness of the pharyngeal muscles can result in residue. While a sensory difficulty can reduce a person's ability to feel the food or drinks at the various stages of the swallowing process.

  • Aging
  • Stroke
  • Neurological disease- incl; Parkinson’s Disease, Multiple Sclerosis, Myasthenia Gravis, Huntington Disease, Motor Neurone Disease
  • Respiratory conditions e.g. COPD
  • Dementia
  • Brain or spinal cord injury
  • Head and neck cancer
  • Cerebral palsy
  • Developmental; and Learning difficulties

A speech and language therapist may carry out a clinical dysphagia assessment.

This might include asking questions to gain a better understanding of the person’s background history including any previous medical reports or assessments.

They will observe the person’s general status such as their respiratory status, their alertness, their oral motor skills and communication status. If appropriate they might trial and assess various foods and fluid consistencies, this may also be carried out through a mealtime observation, based on this assessment and background information, and they may make recommendations.

An instrumental assessment may also be indicated, this may be a Videofluoroscopic Swallowing Study (VFSS) or a Fibreoptic Endoscopic Evaluation of Swallowing (FEES) exam.

  • The SLT has an important role in the diagnosis and assessment of dysphagia.
  • Based on their assessment an SLT will aim to help the person improve their swallowing skills and/or swallowing safety and comfort.
  • SLT treatment may involve swallow rehabilitation exercises to recover and improve function, or the use of compensatory techniques and postures to promote swallow safety, and reduce the risk of malnutrition, dehydration and choking.
  • The SLT may recommend food/drink consistency modification, or alterations to the sensory properties of foods and drinks (e.g. taste, temperature etc).
  • The SLT works with other healthcare staff, particularly dietitians and medical teams, to optimise a person’s nutrition and hydration. The SLT may have a role in determining when transition from one form of nutrition to another is appropriate (e.g. non-oral and oral) 
  • The SLT may work directly with patients, their families and their carers in order to maximise the enjoyment and social aspect of feeding, eating and drinking.
  • The SLT also has a role in the education and training of others in identifying, assessing and treating swallowing problems. This role may include training of patients, families and other healthcare colleagues.

  • Difficulty chewing food properly, and moving food or drink from the mouth to the back of the throat.
  • A feeling that food is stuck in the throat or chest.
  • Regurgitation, or bringing food back up, sometimes through the nose.
  • Coughing, choking while eating and drinking.
  • Persistent drooling of saliva.
  • A 'gurgly' wet sounding voice when eating or drinking.
  • Unintentional weight loss.
  • Repeated chest infections.

Yes. The treatment for dysphagia will depend on multiple factors, including the underlying cause of the swallowing difficulty. Dysphagia can range from a very mild problem, to a very significant problem. Some people will experience dysphagia temporarily, while others might have swallowing difficulties for a longer period of time, and maybe even permanently

The risk factors associated with Dysphagia that is not treated in a timely and/or appropriately include:

  • choking
  • dehydration
  • malnutrition
  • unintentional weight loss
  • difficulty taking medications
  • pneumonia
  • chest infections
  • fear / anxiety / embarrassment / lack of enjoyment 
  • poor quality of life
  • negative social consequences

In order to minimise the risks associated with Dysphagia, and to promote the best outcomes it is important that Dysphagia is treated in the context of a multidisciplinary team who are skilled in the area of Dysphagia.

The speech and language therapist works as part of the multidisciplinary team to support people with swallowing difficulties. This may include but is not limited to the dietitian, the occupational therapist, the physiotherapist, the medical team and nursing staff, carers, chefs and catering staff

In Ireland we use the IDDSI framework to classify modified foods and fluids.

The IDDSI is the international dysphagia diet standardisation initiative, it is a common framework used to describe the different foods and fluids and their consistency. 

Foods are classified from level 0 (normal fluids) to Level 4 (Extremely thickened liquids). Foods are classified from level 4 (puree) to Level 7 (normal diet) Read more

When and how to seek help for Dysphagia?

You should see your GP if you, or someone you care for, have difficulty swallowing or any other signs of dysphagia so you can get treatment to help with your symptoms.

Safe swallowing when short of breath

Download information leaflet

Modified consistency diets: A resource for clinicians and people with dysphagia

Download information leaflet

Modified consistency fluids: A resource for clinicians and people with dysphagia

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