Knowing about Dysphagia

Course overview

What Exactly Is Dysphagia? (Pronounced dis´ fascia) Dysphagia is defined as difficulty managing food in the mouth, inability to chew, or difficulty swallowing thin liquids or regular food textures, which causes coughing or chok¬ing. Dysphagia is evaluated and treated by a speech-language pathologist, who is specially trained in this area. The speech-language pathologist is the newer term for a speech therapist. It is important to understand some very basic anatomy: The trachea (windpipe) sits directly in front of the esophagus (where food travels to enter the stomach). The pharynx is the area from the nasal cavity to the esophagus. See the picture below to obtain a clear view: Dysphagia occurs when there is a problem with any part of the swallowing process. Persons with weak tongue, jaw, or cheek muscles have a difficult time chewing and manipulating food. Other problems include not being able to initiate the swallowing reflex (a stimulus that allows food and liquids to move safely through the pharynx). Thus, a person cannot start the muscle movements that carry the food from the mouth to the stomach. Another common problem may be weak throat (pharynx) muscles, which cannot “squeeze” the food toward the stomach. Here, portions of food or liquid may fall into the trachea (windpipe), causing infection. Dysphagia is not to be confused with Dysphasia, which is a partial or complete impairment of the ability to communicate resulting from brain injury. Causes of Dysphagia? Dysphagia can occur in children and in adults. It may affect the elderly in a more severe manner if the symptoms allow food/liquids to get into the lungs. Common etiologies (causes) of dysphagia include the following: •Head and neck cancer •Parkinson’s Disease •Stroke •Traumatic brain injury •ALS •Cerebellar degeneration •Cerebral palsy •Guillian-Barre Syndrome •Multiple sclerosis •Chronic obstructive pulmonary disease The common factor in these above diseases is some degree of neurological impairment, which in a variety of ways prohibits the oral/pharyngeal musculature to function properly for feeding. Dysphagia can also occur in children with autism, where a hyperactive gag reflex may cause, at worst, projectile vomiting from various types of food. Additionally, oral-tactile sensitivities may cause a variety of food aversions, where the child may only allow a certain texture or temperature of food in his mouth. These difficulties greatly limit the child’s diet and potential for adequate nutrition. Dysphagia is also commonly seen in the elderly. Although a defined neurological impairment may not be evident, the chewing and swallowing function weakens, causing some degree of dysphagia. The elderly with decreased mental status or dementia may also experience dysphagia, as they forget that they have food in their mouth, or forget to complete the actual act of chewing and swallow¬ing food. What Might Happen to a Person with Dysphagia? The most serious consequence is illness or death. This can be due to silent aspiration or aspiration of food matter into the lungs, malnutrition, weight loss, and/or dehydration. A common illness as a result of dysphagia is aspiration pneumonia, which occurs when food enters the lungs. It is not actual food particles that cause pneumonia, but rather the bacteria attached to the food particles. Those with severe dysphagia may con¬stantly choke on food and liquids and may give up eating or drinking due to such difficulty. You will frequently see and hear them choking during eating. This will directly cause malnutrition and dehydration. Most clients with dysphagia will demonstrate denial or lack of aware¬ness of the degree of the problem. Many times we have asked clients if they experience any difficulties eating or drinking. Ninety percent of the time the response is, “Oh, no. I have no problems at all,” but we find some sort of dysphagia after completing a fu