Diagnosing Dysphagia - What are we looking for?
A diagnosis of dysphagia means there is a dysfunction in any area of the swallowing process described in the four phases on the page prior. Speech Therapists get concerned when there are signs of penetration/aspiration, Some even scared. Aspiration is defined as food or liquid entering the airway. Penetration is defined by that food or liquid going down to that airway but being expelled by cough or throat clearing, etc. Penetration/Aspiration is usually suspected at the bedside of the patient and is confirmed through Videofluoroscopy/MBS, or FEES. We note possible penetration/aspiration through cough, throat clearing, change in voice quality or any other overt signs of food or liquid entering the airway during a swallow however it can often times happen silently as well (go down into the airway before, during, or after a swallow without any of those audible signs). The only 100% way we or anyone can for sure say that someone is penetrating or aspirating is if they have a Videoflouroscopy/MBSS or FEES. During Bedside Exams, we can only visualize as far as the oral pathway. We cannot see what is going on ones throat (pharynx/vocal folds) and therefore can not know without proof what is going on in there). Logeman (2006) states however, that approximately 50% of patients who aspirate do not cough or give any external sign of food or liquid entering the airway. The patient's history, medical diagnosis, and other characteristics can assist the clinician in pointing toward the specific swallow abnormality in the oral cavity or pharynx. We all aspirate and penetrate on a normal basis - just not that often, and when you're sick, it tends to happen more often due to secondary factors such as weakness and that's where we get concerned.
Safe Swallow Guidelines
The following are some general guidelines for safe swallowing. Remember that dysphagia patients have individual requirements, so all of these guidelines may not apply to every patient. It is critical to discuss your swallowing instructions with your Speech Language Pathologist and your Physician.
- Maintain an upright position (as near 90 degrees as possible) whenever eating or drinking.
- Take small bites -- only 1/2 to 1 teaspoon at a time.
- Alternate small bites with small sips.
- Eat slowly. It may also help to eat only one food at a time.
- Always avoid talking while eating.
- When one side of the mouth is weak, place food into the stronger side of the mouth.
- At the end of the meal, check the inside of the cheek for any food that may have been pocketed.
- Maintain healthy oral care/oral hygiene.
- Try turning the head down, tucking the chin to the chest, and bending the body forward when swallowing. This often provides greater swallowing ease and helps prevent food from entering the airway.
- Eat in a relaxed comfortable environment.
- Following each meal, sit in an upright position (90 degree angle) for at least 30 to 45 minutes. If possible, take a brief walk to increase gravitational digestion.
- DO NOT drink with a straw (thin or regular) unless specifically advised by your therapist!