June 18, 2024
Dysphagia Management

Innovative Techniques for Dysphagia Management and Clinical Settings

Causes and Symptoms of Dysphagia

There are several potential causes of dysphagia including neurological conditions, structural issues, and medical treatments. Some common causes are strokes, Parkinson’s disease, Alzheimer’s disease, head or neck cancers, cervical spine injuries or diseases, gastroesophageal reflux disease (GERD), and side effects from radiation therapy or chemotherapy.

Symptoms of Dysphagia Management can vary depending on the underlying cause but often include difficulty initiating a swallow, food getting stuck in the throat, coughing or choking during eating, throat clearing after swallowing, sensation of food sticking in the throat or chest, and weight loss due to eating difficulties. Other signs may be wet voice quality after swallowing, holding food in the mouth for long periods, and recurrent pneumonia.

Compensatory Swallowing Techniques

For patients experiencing mild to moderate dysphagia, compensatory swallowing techniques can help modify eating behaviors and swallowing mechanics to make swallowing safer and more efficient. Techniques such as postural changes, alteration of food or liquid consistencies, modification of bite or sip sizes, clenching into the swallow, and double swallowing can be implemented.

Postural changes involve sitting upright with the head extended slightly forward rather than bent down. Chin tucking can protect the airway during swallowing. Altering food textures such as thickening liquids or cutting solids into small, easy to chew pieces can facilitate safer swallowing. Taking smaller bites or sips allows for better control over the bolus. Clenching into the swallow helps direct the food into the stomach by pushing the tongue up to the palate. Double swallowing clears any remaining residue in the mouth or throat.

Swallowing Exercises For Dysphagia Management

For patients who need additional strengthening or retraining of swallowing muscles, exercise programs overseen by a speech language pathologist can be beneficial. Exercises typically progress from dry tasks like tongue holding to food/liquid tasks as the patient’s swallowing ability improves.

Some common swallowing exercises include mendelsohn maneuver, effortful swallow, tongue-hold swallow, super supraglottic swallow, and shower swallow. The mendelsohn maneuver pairs swallowing with chin tuck to move food to the back of the throat. Effortful swallow provides stronger tongue anchoring behind upper teeth. Tongue hold prior to swallow helps direct food backwards instead of spilling out the sides of the mouth. Super supraglottic swallow employs maximal laryngeal elevation. Shower swallow visualizes thin liquid falling to stimulate swallow initiation and trigger the swallow reflex.

Dysphagia Management Techniques

For patients with more significant Dysphagia Management, additional therapeutic techniques may be used under the guidance of a speech language pathologist. VitalStim therapy uses surface electrical stimulation of the swallowing muscles to strengthen and retrain swallowing patterns and reflexes. Thermal-tactile stimulation involves applying warm or cold stimuli to the anterior faucial pillars and soft palate to trigger the swallow reflex.

Mendelsohn maneuver, effortful swallow, and supraglottic swallow can also be used as motor speech techniques during VitalStim or tactile-thermal therapy. Fiberoptic endoscopic evaluation of swallowing (FEES) uses a thin, flexible camera to directly observe the swallowing process, assess swallowing safety and efficacy, and deliver therapy. FEES-guided trials allow for control of bolus size and consistency.

Feeding tube placement may be considered when oral intake is unsafe or malnourishment is a concern. Nasogastric, gastrostomy, or jejunostomy tubes provide nutrition directly to the stomach or small intestine, bypassing the oral and pharyngeal stages of swallowing. Tube feedings are used long-term or as a bridge to oral intake restoration through swallowing therapies.

With a variety of compensatory techniques, exercises, and advanced therapeutic procedures available, most cases of dysphagia are manageable through a multidisciplinary team approach tailored to an individual’s condition and abilities. Regular swallow evaluations allow for treatment progression monitoring. Maintaining patient safety while maximizing oral intake quality of life should be the priority in dysphagia management.

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it