Swallowing Disorders Center

The Swallowing Disorders Center at the Intech Rehab is a unique multidisciplinary program dedicated to the diagnosis and therapeutic management of feeding and swallowing disorders (dysphagia). Evaluation and treatment is offered for both pediatric and adult inpatients and outpatients. Consulting medical and rehabilitation specialists are available as needed. The Center is staffed by Speech-Language Pathologists with extensive training in the anatomy and physiology of the swallowing mechanism. This team of five is dedicated solely to the evaluation and treatment of swallowing disorders.

The Swallowing Disorders Center's "team approach" integrates the expertise of rehabilitation and other medical specialties to ensure complete care of the individual.

Definition of Swallowing Disorders and The Swallowing Mechanism

Definition

Swallowing disorders, or dysphagia, refers to any kind of difficulty in swallowing. Difficulty can arise in any or all of the stages of the swallow mechanism as described below.

The Swallowing Mechanism
Swallowing is divided into four stages:

I. Oral Preparatory Stage - This stage involves preparing the food or liquid to be swallowed. It includes receiving food and liquid in the mouth, keeping food in the mouth, moving the food from side to side, and chewing.

II. Oral Stage - This stage involves moving food/liquid from the front to the back of the mouth. It requires adequate lip, tongue, and cheek movement and strength.

III. Pharyngeal Stage - This stage involves movement of the food/liquid through the throat into the esophagus (the tube connecting the throat to the stomach). During this stage, adequate protection of the airway is needed to prevent misdirection of material into the airway.

IV. Esophageal Stage - This stage involves movement of food through the esophagus and eventually into the stomach.

Who Has Dysphagia?

Dysphagia can occur in both children and adults.

Dysphagia is fairly common in individuals with the following medical conditions:

• Stroke
• Head and neck trauma or surgery
• Cancer
• Traumatic brain injury
• Progressive neurological disorders (Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Huntington's chorea, muscular dystrophy, myasthenia gravis, and others).
• Alzheimer's disease or other forms of dementia
• Complications from general surgery

Dysphagia often occurs in children with:

• Developmental delays
• Cerebral palsy
• Prematurity
• Failure to thrive
• Craniofacial abnormalities
• Genetic syndromes
• Complications from surgery

Symptoms of Dysphagia

How Do I Know If I Have Dysphagia?

Symptoms of dysphagia can include the following:

• difficulty in eating and swallowing
• coughing or choking during meals
• pain during swallowing
• sensation of food lodged in the throat
• aversion to accepting food/liquids of different flavors, textures, or temperatures

Dysphagia may also be suspected if you have episodes of unexplained respiratory infections or asthma, repeated incidents of pneumonia or symptoms of reflux (heartburn).

Many swallowing problems go undetected until severe consequences develop, such as malnutrition, dehydration, pneumonia, or failure to thrive.

A comprehensive swallowing evaluation is the best way to determine if you have dysphagia.

How Do I Know If My Child Has Dysphagia?

Coughing or choking during meals may indicate a problem with swallowing. However, children may exhibit other symptoms and behaviors that could also point to a feeding difficulty. These could include, but are not limited to, gagging while eating, vomiting, refusal to accept different flavors or textures of foods, or difficulty progressing to age-appropriate food consistencies (i.e., from baby food to chewable food).

Feeding difficulties are often seen in children who have experienced medical problems at a very young age. Gastrointestinal, respiratory, and neurological issues may aggravate feeding problems.

Evaluation of Swallowing Function

Patients who are referred to the Swallowing Disorders Center receive a comprehensive evaluation, starting with a clinical assessment of their swallowing function. This includes an in-depth patient interview to collect pertinent medical history, feeding and swallowing history, and the patient's complaint(s). An extensive examination is performed of the oral structures. A feeding observation may be obtained.

If indicated, a videofluoroscopic study (modified barium swallow) of the oral and pharyngeal swallowing mechanism is performed. These moving radiographic images are recorded on videotape and can be reviewed once the study is completed. The study involves an x-ray of the mouth and throat while the patient is eating and drinking. It provides an objective assessment of the swallowing function and helps to determine an appropriate management and treatment plan.

Results of the swallowing evaluation are communicated to the referring medical practitioner. If requested, referrals to other specialists (in the fields of gastroenterology, pulmonology, neurology, otolaryngology, nutrition, psychology, etc.) are available. Referrals are made to these specialties when it appears that additional diagnostic modalities and/or treatments may enhance the comprehensive plan of care.

Treatment for Dysphagia

The Center's swallowing specialists will determine an appropriate treatment approach and plan for each patient, taking into consideration a number of factors, such as the patient's medical diagnosis, nutrition, and mental status.

Dysphagia treatment offered by the Swallowing Disorders Specialists is customized for each patient and may involve modifying the types of foods and liquids taken, providing exercises to strengthen the muscles of the mouth and throat, and/or teaching head and neck postures and strategies to allow for comfortable and safe eating.

The Swallowing Disorders Center's approach to treatment involves the use of multiple modalities to enhance patient progress. In addition to traditional swallow rehabilitation, Neuromuscular Electrical Stimulation (E-Stim) has been incorporated into treatment protocols when applicable.

After the initial management plan is designed and put into practice, each patient is followed carefully to monitor improvement and detect any needed changes in treatment. Family members are encouraged to become involved in ongoing treatment.

The goal of the Swallowing Center is to help individuals regain normal swallow function and eat safely to improve their health and quality of life.