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The premier source of information for the management of patients with Dysphagia

Treating dysphagia

Apart from surgical interventions for restoring swallowing function, swallowing function might be restored through functional rehabilitation (dysphagia therapy). Functional swallowing rehabilitation can be divided into three different approaches: swallowing rehabilitation, compensatory strategies, and the use of dietary adjustments (3).

Swallowing rehabilitation

Swallowing rehabilitation consists of exercises targeted to train specific muscles or muscle groups. This can be, for example, exercises which improve the function of the tongue muscles, so that the patient is able to make a better, more homogeneous bolus in the mouth prior to swallowing. There are also exercises to improve laryngeal excursion and pharyngeal contraction (3,4,5).

Compensatory strategies

Compensatory strategies allow patients to swallow safely even though their underlying physiology is impaired. The patient learns how he can avoid problems during eating and drinking (such as choking, coughing). Compensatory strategies are mainly aimed at changing the position of the head during swallowing or using special swallowing techniques. An example of a compensatory strategy is swallowing with a ‘supraglottic swallow’ (3). The patient learns to hold his breath prior to swallowing and is taught to close both true and false vocal folds when swallowing. After swallowing the patient deliberately coughs to clear any possible residue. Aspiration cannot occur as the larynx is fully closed and possible residue is cleared (3).

Dietary adjustments

A third therapy option is changing the consistency of a patient's diet in the patient’s diet. A Speech and Language Therapist examination, flexible endoscopy or videofluoroscopy is used to determine which consistencies and which quantities the patient is able to swallow without problems. In stroke patients there is a significant chance that aspiration will occur with thin liquids. When a videofluoroscopy shows that thicker liquids are not aspirated, the thin liquids in the patient’s diet can be thickened with commercially available thickening powders. These products are manufactured by many different commercial companies. These companies also provide ready-made ‘thickened’ drinks and puddings for patients with dysphagia. Apart from changing the consistency of the food, the temperature can also be adjusted. It is well-known that receptors in the oral cavity and pharynx that trigger the swallowing reflex are more sensitive to colder stimuli. Therefore it is often advised to start oral feeding with cold food, such as ice water, cold custard, etc. (3).


REFERENCES:

3. Logemann, J. (1999). Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed.

4. Rofes, L., Arreola, V., Akmirali, J., Cabré, M., Camins L., García-Peris, P., Speyer, R., Clavé, P. (2011). Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology Research and Practice Volume 2011, Article ID 818979, 13 pages.

5. Schindler, A., Vincon, E., Grosso, E., Miletto, A.M., Rosa di, R., Schindler, O. (2008). Rehabilitative management of oroopharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital. Dysphagia 23, 230–236.

 

 


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