A Multi-Disciplinary Approach to Dysphagia Therapy

Dysphagia can occur at any age and can present differently in clients based on the cause.

Although eating can seem intuitive for most people, the actual act of eating is a surprisingly complex task. It requires multiple mechanical skills, including bringing food to the mouth, chewing, and swallowing. The process can present challenges for significant segments of the population. 1 in 6 adults can have difficulties swallowing food and liquid due to weak or poorly coordinated muscles, a condition known as dysphagia.

Dysphagia can occur at any age and can occur in patients who have:

• Parkinson's disease
• Stroke
• Chronic obstructive pulmonary disease (COPD)
• Dementia
• Trauma to the neck area

Recommended course: Diagnosis Matters: Understanding Dysphagia Causes in Medical Conditions

Signs and symptoms of dysphagia

While dysphagia can present differently in clients based on the cause, generally, the symptoms of dysphagia include:

• Pain while swallowing
• Inability to swallow
• Feeling as if food is stuck in the throat or chest or behind the breastbone
• Drooling
• Hoarse voice
• Vomiting
• Frequent heartburn
• Food or stomach acid backing up into the throat
• Weight loss
• Coughing or gagging when swallowing

The dangers of dysphagia

For clients whose primary means of nourishment is oral intake, difficulty swallowing can deter them from eating foods they prefer. As a result, dysphagia can lead to malnutrition or dehydration. Dysphagia can also cause aspiration pneumonia, which can lead to death in medically compromised clients.

A multi-disciplinary approach to dysphagia

A multi-disciplinary team is essential for the identification of dysphagia and treatment of dysphagia and its secondary effects. Interprofessional practice (IPP) has been shown to improve client outcomes. An American Speech-Language-Hearing Association (ASHA) article states, “95% of speech therapists . . . participate in IPP because it improves patient . . . outcomes.”

A collaborative team can include:

• Nurses
• Doctors
• Dietitians
• Occupational therapy practitioners (OTPs)
• Speech-language pathologists (SLPs)

As nurses spend a lot of time with patients, they may be the first to notice a patient is having difficulty swallowing. Under the guidance of a dietitian, clients will have access to foods that meet their nutritional needs. Doctors can diagnose and refer clients to specialists such as SLPs and OTs to address swallowing difficulties and feeding mechanics.

Speech-language therapists and dysphagia

SLPs are skilled at providing dysphagia interventions. The American Speech-Hearing-Language Association lists the primary goals for dysphagia interventions as:

• Support adequate nutrition and hydration and return to oral intake (including incorporating the patient’s dietary preferences and consulting with family members/caregivers to ensure that the patient’s daily living activities are being considered).
• Determine the optimum supports (e.g., posture or assistance) to reduce patient and caregiver burden while maximizing the patient’s quality of life.
• Develop a treatment plan to improve the safety and efficiency of the swallow.

A client with these challenges can choke and is at risk for aspiration. An SLP can recommend food textures to decrease or eliminate the aspiration risk. SLPs can also facilitate exercises to strengthen the muscles involved with chewing and swallowing to increase safety while eating.

Occupational therapy and dysphagia

Occupational therapy practitioners (OTPs) are skilled at assessing and addressing the barriers to safe eating and can address the occupational performance implications of having dysphagia.

• Seating and positioning for meals. A study published in 2017 found that sitting upright allowed for the least difficult swallowing. The study concluded that modifying the postures of clients with dysphagia can affect the speed and safety of swallowing, therefore decreasing the chances of aspiration
• Patient and caregiver training
• Recommending adaptive equipment that slows the flow of liquid or makes it easier to cut up foods for eating with less discomfort and increased safety.
• Difficulty using eating utensils or finger feeding due to poor hand-eye coordination, poor fine motor skills, or poor executive functioning skills. An OT can work on hand-eye coordination, fine motor strength, and the upper body coordination needed to bring the food from the plate to the client’s mouth.
• Determining a meal schedule that maximizes the client’s strength. An OT can assist the client and caregivers with determining when the patient has the most energy and is the most cognitively alert and determining the level of support needed during each meal based on the client’s abilities.
• Sensory processing difficulties can affect a client’s toleration of food textures. This can result in a client gagging, vomiting, or refusing to eat. An OTP can determine which food textures are best tolerated while adhering to recommended textures for safety.

OTPs can also address the psychosocial impacts of dysphagia. A client who has difficulty swallowing may not engage in family meals or social events surrounding food. As a result, this can have adverse effects on their mental health and social support system. OTPs can assist the client with determining ways to engage in the social aspects of eating without compromising their physical health.

Surgical interventions and dysphagia

Although non-surgical methods are available to address dysphagia and its effects, some clients benefit from temporary or permanent solutions that circumvent the necessity for oral intake or supplement oral intake. A feeding tube can be placed via a surgical procedure to ensure a patient is getting adequate nutrition.

Depending on the patient’s other medical diagnoses, it’s possible for them to be independent with their tube feedings after receiving proper training.

Conclusion

Although dysphagia can further compromise the health of a client, surgical and non-surgical methods are available to address its effects. A multi-disciplinary team approach effectively provides well-rounded support that encompasses the client’s medical, physical, and psychosocial needs.