Dysphagia

What is Dysphagia?

Dysphagia is the medical term used to describe difficulty swallowing food and/or drinks. It may occur if there is decreased sensation, strength or control of the muscles of the mouth or throat.

What causes Dysphagia?

A swallowing problem may arise as a side effect of many conditions, such as:

Stroke
Cerebral palsy
Head injury
Motor neurone disease
Multiple Sclerosis
Parkinson's disease
Surgery to the head and neck

What do we do?

Speech and Language Therapists assess how well a person's swallow is working by looking at the muscles involved in the swallow process. This is done simply by asking a person to follow some basic instructions to look at oral movements (e.g. stick your tongue out) and also involves the person having something to eat and drink.

Description of service

The majority of assessments take place in the outpatient clinics in the Speech & Language therapy department. The appointment can last approximately 40 minutes depending on the nature of the dysphagia.

If a more detailed assessment is required then a person may be referred on for a videofluoroscopy.

Home visits are arranged for residential and nursing home residents. Also if it is difficult for people to attend the hospital due to mobility issues, then a home visit can be arranged through discussion with the department.

Inpatients within York Hospital, Selby Hospital and Community Reablement Units for the Elderly are seen directly on the wards.

How do you access us?

Inpatient Referrals: Wards refer patients with difficulties directly to the department and they are seen for an initial assessment within 2 working days of receipt of the referral (Royal College of Speech & Language Therapists Guidelines).

Outpatient Referrals: These are made by GPs, Consultants or Specialist Neurology Nurses. Once a referral is received, it is triaged and an appointment is arranged.

For further information, please contact the department on 01904 725768 or email our dysphagia specialist Helena Perry: helena.perry@york.nhs.uk

What difficulties can occur?

If the muscles used for swallowing are affected, one or more of the following may occur:

Difficulty biting or chewing
Difficulty moving and controlling food in the mouth
Difficulty keeping food in the mouth
Decreased awareness/sensation of food in the mouth which may fall into the throat
Food or liquid getting stuck in the throat
Food or liquid going into the trachea causing coughing or choking
Food or liquid going into the lungs causing a chest infection or pneumonia

How are swallowing problems managed?

A person's swallow is assessed to find which muscles of the swallow have been affected and how severe the problem is. Some people with dysphagia can eat and drink but may need the texture of their food and drink to be modified. As the person's condition changes, their diet is gradually modified by the Speech and Language Therapist.

If the swallowing problem is very severe and most food and liquid is likely to go into the lungs, the person may not be allowed to have food or drink at all. If this situation persists for a few days, the person may need to be fed through a tube going from the nose down to the stomach (called a nasogastric tube/NG tube) or by a tube that goes directly into the stomach (called a PEG).

What are thickened drinks?

A thickening powder is added to liquids in order to change the consistency. This is done as thickened drinks are easier to control in the mouth and do not spill down as quickly into the throat as do normal/thin drinks.

Pureed diet:

Pureed food consistency is recommended when the tongue, mouth or throat muscles are too weak to chew and swallow normal food.

Soft diet:

Soft food requires some chewing, but normal muscle strength and teeth are not necessary. This means that you can eat more, more easily.

For further advice regarding modified diets and fluids, please contact the Speech & Language Therapy Department on 01904 725768.

How long will the swallowing problems last?

Swallowing problems and their progression vary greatly depending on the cause of the dysphagia. Some individuals may require long term use of alternative feeding or a modified diet. In other cases, their dysphagia may completely resolve. It is best to consult a Speech and Language Therapist regarding this.

Is there anything others can do?

Meals should be supervised or monitored
During meals, the person should be sitting supported; in an upright position. The person should eat slowly, one mouthful at a time. Making sure that each mouthful is swallowed before the next one is taken
Minimise distractions
The person should sit up for half an hour after meals
The Speech and Language Therapist may have given specific instructions regarding feeding. Please follow these very carefully.
If the person is having obvious difficulty, contact the Speech and Language Therapist
Ensure good oral hygiene - the person's mouth should be clear of all food after meals and teeth should be brushed regularly.