Dysphagia - WNY Speech Therapy

What is Dysphagia?

Swallowing to eat, drink and manage our saliva is a multiple step process which includes the ability to taste the food, chew and mix the food with saliva into ball like shape (called a bolus)(oral stage), move the “ball” from our mouth, through the throat (pharyngeal stage) and finally into the esophagus. A swallowing problem or disorder occurs when any one or more of the steps to swallowing are impaired, thus changing either the speed, safety and effectiveness of the swallow. Some swallowing problems cause discomfort, coughing and/or choking and may be a serious health risk due to the possibility of food/liquid entering the lungs. Some swallowing problems may not be noticeable to the patients, but they have serious repercussions to the health.

Symptoms

Coughing and choking when eating and/or drinking
Gurgly vocal quality with and/or after eating
Excessive throat clearing while eating
Runny nose, watery eyes and/or sneezing at meals
Difficulty taking medications
Significant weight loss and/or history of poor intake at meals
Low grade temperature of unknown origin
Increased pulmonary congestion

Assessment

Swallowing skills can be assessed by a Speech Language Pathologist.
Assessment includes evaluation of oral motor control, as well as reviewing the ability to consume various foods/liquids.
An xray study of the swallow known as a
Modified barium swallowing study (MBS)/videoflouroscopic swallowing study
May be requested

Treatment of Swallowing can include:

Modification of food consistencies, modification of posture/positioning while eating, use of direct swallow techniques to sequence, reinforce and protect the swallow, direct oral/throat exercises to strengthen the muscles used to swallow.

Modified Liquid Consistencies

For use with nectar, honey or pudding thick liquids.

Individuals on a thickened liquid diet should have nothing thinner than the liquid consistency recommended.

On any thickened liquid diet avoid gelatin, sherbet, ice cream, and ice cubes, because they will melt into a thin liquid and could cause choking or aspiration (liquid going into the lungs). Also avoid any juicy fruits such as watermelon, pineapple, etc.. which have thin juices. These may cause choking or aspiration. Cooked vegetables and canned fruit should be drained. Soups should be thickened to the recommended thickness.

Any liquids can be thickened: water, milk, juice, coffee, tea, hot drinks, milkshakes, soup.

Suggestions for liquids already nectar thick:

Appropriate thickeners: Baby food (ie applesauce, prunes)
Commercial thickeners- Simplythick

To thicken liquids using a commercial thickener:

Determine which thickness you need: nectar, honey or pudding.
Measure the amount of liquid and thicken according to the instructions on the side of the canister.
Blend well. If the mixture looks too thin, wait one (1) minute.
Some liquids thicken faster than others depending upon temperature and type of liquid.

Pureed Diet

The pureed diet is used for individuals who experience difficulty with chewing or swallowing foods. Foods are blenderized, or pureed to a consistency of mashed potatoes.

Meats

Any meats that are bakes, broiled, strained, or roasted, then pureed are appropriate. These meats may be served with gravy. Cottage cheese and eggs may also be pureed.

Vegetables

Most vegetables are appropriate to puree. Avoid pureeing “stringy” vegetables such as celery and asparagus.

Fruit

Most fruits may be pureed: ie applesauce. Avoid pureeing foods with a membrane such as oranges and grapefruit.

Breads and Cereals

All cooked cereals. Soft doughnuts, pancakes, waffles and French toast may be pureed. Avoid cold cereal.

Soups

Choose any smooth cream or broth-based soups with pureed ingredients, i.e. potato soup, chicken soup.

Desserts

Choose pudding, gelatin, sherbet, ice cream, whipped topping. Cakes, cobblers, pies, and soft cookies may be pureed.

If an individual is on thickened liquids, all think consistencies should be thickened to the recommended thickness.
To help with bringing pureed foods to a desired consistency, commercial thickeners may be added

Mechanical Soft Diet

The Mechanical Soft Diet is for individual who experiences difficulty with chewing or swallowing foods. This diet includes foods that are soft and meats that are ground. All puree foods are appropriate.