Dysphagia!
Problems and solutions to consider in treating swallowing disorders
by Michael E. Groher, Ph.D., Speech Pathologist

What is dysphagia?
Dysphagia, or difficulty in chewing and/or swallowing, is a medical disorder that affects a surprisingly large population of children and adults-an estimated 6 to 15 million people in the United States. Despite the significant number of people afflicted with dysphagia, it has nonetheless been described as a hidden condition.

Fortunately, new solutions and treatments are improving both the health and the quality of life of dysphagic patients, and they are addressing the needs of caregivers as well.

Dysphagia is not a disease, but a symptom of disease-a mechanical dysfunction caused by an underlying medical condition. Simply stated, a person with dysphagia is unable to pass food or liquid rapidly or efficiently from the mouth to the stomach. The problem can occur in the mouth, throat, or esophagus and it can result in discomfort, choking, chest pain, respiratory irritation, or an inability to make a complete swallow.

Typically speech and language pathologists pinpoint and diagnose different types of dysphagia. The degree of severity can range enormously. Patients are being treated for this condition in hospitals, long-term settings, residential facilities, and at home. The problem can be temporary, following an accident or the onset of an acute illness. It may be episodic, or it may be long term or permanent.

What causes dysphagia?
A broad range of medical conditions can cause dysphagia. The following encompass the major causes, yet other conditions can contribute to this condition as well.

• Stroke

• AIDS

• Alzheimer's Disease

• Other conditions associated with aging

• Traumatic brain injury

• Myasthenia Gravis

• Parkinson's Disease

• ALS

• Down's Syndrome

• Cerebral Palsy

• Oral or plastic surgery

• Face, neck, or chest injury

• Cancer

• Spinal cord injury

• Multiple Sclerosis

• Loss of dentition/bite force

• History of aspiration or pneumonia

• Birth defects

Swallowing is a relatively complex function
Although for most of us swallowing seems to be a simple, quick, and effortless function, it is actually comprised of a series of essential steps. Medical professional are increasingly emphasizing the psychological and motivational components that factor into the process as well. Such elements begin even before we put food into our mouths. The visual appreciation and the ambiance of the eating circumstance undoubtedly contribute to the success of ingestion.

Mechanics of swallowing
The swallowing response encompasses three physical stages: oral, pharyngeal, and esophageal. The process works as follows:

• Bite and chew food in the mouth. This oral stage is dependent on adequate moisture and on the sensory inputs from food that include taste, texture, temperature, and pressure. 

• Food passes from the back of the mouth to the pharynx.

• Sensory inputs form chewed food chewed food at the back of the mouth trigger nerves that send a signal to the brain that begin muscle contractions known as the swallowing response.

• The tongue propels the food into the throat and finally into the esophagus. 

• Food passes through the esophagus into the stomach.

Once the swallow starts, the food or liquid passes through the throat in less than one second. The vocal cords close to protect the lungs. Once the food reaches the esophagus, it moves more slowly.

Effects of dysphagia on swallowing
When the swallowing muscles are weakened from disease or trauma, the reparation and delivery of food and liquids become difficult. Among the problems that can arise in the swallowing function among people with dysphagia are:

• Lack of strength, control, or feeling in the mouth. Chewing and food movement by the tongue may be labored.

• The swallowing reflex may be delayed, incomplete, or absent.

• Food may become trapped in the natural crevices or recesses in the pharynx.

• The larynx may not lift or may not close. Food or liquid may not be directed to the esophagus, but may go into the airway, causing choking or breathing difficulty.

• There may be abnormal muscle contractions in the esophagus. Disorders of the esophagus can cause further delay in the passage of solid food.

Dysphagia, if left untreated, can result in weight loss and/or malnutrition, which, in turn, can cause an increased risk of infection, impaired mental abilities, and other serious health consequences, as well as a reduced quality of life. Therefore, treatment is critical.

Solutions
Each type of swallowing problem requires its own specialized treatment plan. In limited situations, corrective surgery may be an option. Solutions an also involve behavioral changes, which might include a change in the person's posture as well as specific swallowing maneuvers to compensate for poor muscle movements. 

Diet, however, is a vital component in the treatment of virtually every dysphagic patient. The following are crucial components of dietary treatment.

Food consistency
Treating dysphagia almost always involves changing the consistency of foods and liquids in the person's diet.

Some people have difficulty swallowing solids, some have difficulty with liquids, and some have problems with both. Interestingly, a greater number of people with oral or pharyngeal dysphagia have problems swallowing liquids more than solids. Liquids require more precise tongue control to hold the liquid against the roof of the mouth until the swallowing reflex is triggered.

Safe solid foods and thicker liquids can help produce more saliva to aid in swallowing. This may help strengthen muscles used in moving the tongue and chewing.

Sensory stimulation is foremost 
Although the issue of food consistency is foremost, providing a diet which is high in sensory stimulation also helps by triggering the swallow response. Food items which have sufficient taste, temperature, texture, and pressure help trigger this response. Improved feeding solutions further address the issues of the patient's motivation as well as improve his or her quality of life.

Consistency-modified meals now available
Breakthroughs in home meal solutions include options which not only provide excellent nutrition, but also address the patient's culinary desires.

One such dietary solution, consistency modified meals, is now available for use in the home environment. These meals offer breakfasts, entrees, deli specialties, and desserts with a souffle-like consistency. They are tasty, high in sensory stimulation, and nutrient dense. Because these meals are made with wholesome ingredients and designed by culinary professionals, patients tend to eat more and thus retain vital nutrients. An additional benefit for patients and /or caregivers is the convenience they provide in terms of time and ease of preparation. 

In conclusion, improved dietary selections can dramatically improve the overall quality of life of the dysphagic patient by restoring the simple pleasure of enjoying a tasty meal with friends and family.

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