Dysphagia

Dysphagia is a swallowing disorder classified by any abnormality in the movement of food from the mouth to the stomach.

This may include:

  1. The difficulty in recognizing food in the mouth
  2. The difficulty in placement of food in the mouth
  3. The difficulty in controlling food in the mouth
  4. The patient coughs before, during and/or after feeding
  5. The patient has chronic pneumonia
  6. Weight loss for no apparent reason
  7. A gurgly voice quality
  8. An increase in secretions in the pharynx or chest after the patient swallows
  9. The patient complains of swallowing difficulties
  10. The patient feels full all the time

Causes of Dysphagia

  • Traumatic brain injury
  • Stroke
  • Cancer of the head and neck
  • Cerebral palsy
  • Guillian Barre
  • Multiple Sclerosis
  • Parkinsons’ disease
  • Cranial nerve damage
  • Infections (HIV/AIDS)
  • Ageing
  • Respiratory disorders

The speech therapist’s role in Dysphagia

  1. Evaluation of swallowing:
    The speech therapist will evaluate the patient’s ability to swallow safely. They will assess the patient swallowing ability on various consistencies of food and fluids, which they can handle in their diet, as well as where in the system the problem is (oral, pharyngeal, oesophageal).
  2. Therapy:
    The therapist will show the patient various techniques or manoeuvres to help them in the swallowing process. They may adapt their diet (along with the dietician’s input) to suit their swallowing and nutritional needs. Along with this, they will determine the need for alternative feeding methods (NG-tubes, PEG tube etc)
  3. Positioning:
    The speech therapist will ensure that the patient is upright (90 degrees) with the head supported by pillows during feeding times. The patient’s chin must be slightly down towards the chest, in order to protect the airway. The patient must remain upright for 20 – 30 minutes after eating if possible.

What is aspiration?

Aspiration or aspiration pneumonia may occur when a patient has Dysphagia (difficulty swallowing food or fluids). This occurs when a patient swallows a food or fluid bolus and the substance goes into the lungs, the patient usually chokes/coughs, and this is called aspiration. If this occurs multiple times, it may cause aspiration pneumonia. Patients usually aspirate on thin fluids, such as water, or food consistencies which have smaller pieces, such as rice, mince or oats.

What is thick and easy?

‘Thick and Easy’ is a powder which is mixed with fluids to make them thicker. It has no nutritional value, however it helps aid the patient in better swallowing of fluids and reduces the risk of aspiration. In South Africa, it is predominantly made by a company called Fresinius Kabe.

What is a NG tube? What is a PEG tube? When will this be recommended?

A Nasogastric Tube (NG Tube) is a feeding tube which is inserted through the nose down the throat and into the stomach. It is used as a temporary measure of feeding a patient with swallowing difficulties or an unconscious patient. A NG Tube can be kept in for approximately 6 – 8 weeks. Thereafter, if non-oral feeding is still required, a PEG tube will be recommended as a safer, more long-term alternative.

A PEG Tube, also known as Percutaneous  Gastrostomy Tube, is an alternative feeding method which involves a more intensive insertion. A PEG tube can be inserted under anestethic and is done by making an incision close to the stomach for this tube to go into the stomach directly. This tube bypasses the throat and Oesophagus completely. It is still visible outside the stomach though and as with all open wounds, will need sufficient care and recovery. This is required when the patient has more long term swallowing difficulties and is often used as an interim measure for feeding while the speech therapist is aiding the patient in swallowing more effectively. A PEG tube can be recommended by a Doctor, Speech Therapist and/or Dietician and has to be inserted by a qualified surgeon.

Guidelines for family members with swallowing difficulties:

  • Be aware of the individuals swallowing program and strictly follow the guidelines provided.
  • Provide support for the person undergoing the swallowing program
  • Give only food according to the consistency prescribed by the speech therapists.
  • Remember that the person must sit upright during all feeding times, unless otherwise recommended.
  • Encourage the person to only take in small amounts of foods at a time.
  • Give enough time for feeding, that meals are not rushed.
  • Make sure that the person swallowed and his mouth is empty before giving another mouthful.
  • Stop feeding if the person begins to choke.
  • Let the person stay upright for 20-30 minutes after all oral feeds.