• Dysphagia affects 18 million people in the USA (AHCPR, 1999)
• 50-75% of stroke patients and 60-70% of patients who undergo radiation therapy for head and neck cancer have dysphagia (Mann et al., 2000; Nguyen et al., 2006; Nguyen et al., 2008)

I’m having Trouble swallowing- What could it be?

Dysphagia or difficulty swallowing- can be the result of a variety of pre-exiting conditions, or the onset of new medical conditions. It can be extremely difficult to diagnose dysphagia without appropriate instrumental tests. Here are some common causes of dysphagia that we see at DVT:

1. Structural (osteophytes, scar tissue, radiated muscle tissue from cancer treatments, surgical complications)
2. Neurological (stroke, Parkinson’s Disease, dementia, TBI)
3. Cancer (mouth, tongue, throat, voice box)
4. Medication Induced (antipsychotic/neuroleptic, meds that dry the mouth

What Should I do if I have trouble swallowing?

The first step is to communicate your concerns to your Primary Care Provider (PCP)/Family Medicine Physician (MD). Discuss with your PCP a referral to a Speech Language Pathologist who specializes in Dysphagia assessment/treatment. At DVT we specialize in assessment and treatment of dysphagia. We are also fortunate to have a collaborative work relationship with the Otolaryngologists of Pinehurst Surgical ENT. Therefore, if we feel an additional referral to the ENT is more appropriate prior to beginning comprehensive dysphagia treatment, we will make the necessary ENT referral for additional workup.

What is it? This is an electrical stimulation by way of electrodes applied directly to the skin of a patient’s neck or face muscles depending on which muscles the SLP intends to treat. When NMES is applied to the skin at low levels it activates sensory nerve endings in the surface layers which provides sensory feedback to the peripheral and central nervous system. When the electrode firing increases the electrical stimulation penetrates deeper resulting in muscle contractions. The goal of using NMES is to induce muscle strengthening, increasing range of motion in a target muscle. At DVT we combine NMES with food/liquid trial swallows and swallowing exercises to stress/overload the swallowing muscles. At DVT we are trained exclusively in Ampcare’s Effective Swallowing Protocol (ESP).

Dysphagia is frequently accompanies most progressive neurological diseases. We know that these diseases are progressive in nature and feeding/nutritional goals will change over time. Dysphagia symptoms may be mild at some stages of the disease and progress to more moderate to severe symptoms presenting nutritional challenges for our patients. At DVT our goal is to collaborate with the patient, family and caregivers, and other health professionals to provide dysphagia assessment/management that maximizes feeding/nutritional safety and improves quality of life for our patients at all stages of the disease process.

Treatment and management for dysphagia is patient specific depending on many factors related to the patients overall medical diagnosis and history. Prior to initiating dysphagia treatment, the SLP begins with an exhaustive review of the patient’s medical records, diagnosis, current prescribed medication list, discussion with the patients primary care provider and finally patient/family interview. Once the SLP has determined the patient is appropriate candidate for dysphagia treatment and management, the SLP begins with a clinical swallow examination. After the clinical swallow examination is completed, the SLP will conduct imaging studies either using FEES or MBSS.

Dysphagia Assessment

• Clinical Examination- MASA
• Functional Status- FOIS
• Patient Perspective-VAS
• Imaging Studies- FEES/MBSS

Dysphagia Treatment

• McNeil Dysphagia Therapy Program (MDTP)
• Compensatory Strategies
• Therabite-trismus exercises
• Swallowing maneuvers
• Oral Motor Exercises
• Neuromuscular Electrical Stimulation(NMES)