by Judy Mortellite, MS/CCC, SLP, Gazette Contributing Writer
 

Many patients often ask, “Why does a speech pathologist work with people who have trouble swallowing?” The same mechanisms we use for speech are those we use for swallowing. In fact, at least 50 percent of the patients that speech pathologists work with, including in-patient, out-patient, sub-acute, long-term and home health, have swallowing problems, or dysphagia.
Dysphagia can be the result of many conditions, most commonly stroke, but also brain injury, congenital defects, head/neck cancer, and even progressive degenerative diseases such as MS, Parkinson’s and Alzheimer’s.
Symptoms can be overt, such as coughing or choking when eating or drinking, or silent, such as increased temperature or weight loss. In the throat, the trachea carries air to and from the lungs while the esophagus transports food to the stomach. The trachea and esophagus are in a “back to back” position.” In a normal functioning swallow, the trachea is protected from the entrance of food and liquid. When dysphagia is present, the reflexes that function to protect the airway are impaired, and food and liquid can fall into the trachea resulting in “penetration.” The vocal folds, which vibrate from the movement of air in the trachea to produce voicing, also act as another barrier to protect the lungs from materials. When food and liquid fall below the level of the vocal folds, “aspiration” has occurred and the patient is at risk for pneumonia secondary to the presence of foreign materials into the lungs.
A speech pathologist can do an initial bedside evaluation offering various textures and consistencies of food and liquid and assessing the timing, strength, and coordination of the patient’s swallowing function. Strength and range of motion of the oral musculature will also be assessed for ability to manipulate various textures, as well as the swallowing reflexes. To further rule out or confirm aspiration, a videofluoroscopic swallowing study, which is a moving x-ray of the swallowing function, can be performed.
Once dysphagia and/or aspiration has been confirmed, a speech pathologist can develop a treatment plan that will enable a patient to improve or regain safe swallowing function. Treatment can include strengthening exercises, compensatory strategies, neuromuscular re-education, and mechanically altering food and liquid textures. With treatment, many patients are able to enjoy food and liquids safely.