​We caught up with Hayley Herman and Sherry Darling, Speech-Language Pathologists at TWH. Speech-Language Pathologists assess and treat communication and swallowing disorders. They gave us the inside scoop on swallowing disorders and what we can expect from Speech and Hearing Month.

What is a swallowing disorder?
Dysphagia, the medical term for swallowing difficulty, is any kind of complication a person may have in oral pharyngeal or esophageal phases of the swallow. It is a disorder that involves getting food from mouth to stomach.

What causes swallowing disorders?
There are many causes of Dysphagia. Below are a few examples:

  • Neurological conditions such as stroke, Parkinson's, Lou Gehrig's Disease (ALS)
  • Structural medical problems including head and neck cancers and treatments for cancer like radiation
  • Medically induced problems as result of medications, prolonged intubation, tracheotomies (breathing tube in the neck)
  • Cognitive issues such as dementia

What are some common problems that may develop as a result of a swallowing disorder?
The most dangerous issue that may arise is aspiration, when food and liquid get into the lungs; this can cause choking and is even more likely to cause pneumonia. This is the leading cause of death for patients affected by Parkinson's disease and stroke. Other consequences include inadequate nutrition and hydration as well as poor quality of life and social isolation. Eating meals with friends and family is a very social activity; for people with swallowing disorders, it can be very overwhelming. Sometimes they feel embarrassed or physically they need to eat in silence so they can concentrate on the intake of food. They often feel isolated from social events and have restricted diet textures; this can take both an emotional and psychological toll.

How do Speech-Language Pathologists assess a swallowing disorder?
In an acute care setting, we assess for swallowing difficulties. This means that clinical bed side assessments are a crucial part of our job. We review the patient's history for possible causes and perform oral motor exam to test strengths, range of motion and the way the muscles move. We also test various textures and consistencies to assess what the patient can and cannot manage safely by mouth.We also rely on instrumental assessments which include a video fluoroscopy (a moving x-ray of the swallow) and FEES (fibre optic endoscopic evaluation of swallowing) which allows us to observe the patient's swallow by camera.

What is the most common treatment for swallowing disorders?
We try to help rehabilitate the swallow through exercises or postural manoeuvres. A common swallowing exercise is "masako"; in this exercise, the patient is encouraged to hold their tongue tip between their teeth and swallow saliva. This strengthens the back of the tongue and muscles in the pharynx. Another common strategy is texture modification which is altering the textures of foods and liquids. This may involve thickening liquids or pureeing solids.

What is the success rate for treating swallowing disorders?
In the best case scenario, they can go away – but it depends on the underlying cause; it's different for every diagnosis. For patients affected by Parkinson's disease or ALS, our objective is to preserve swallowing function for as long as possible. With stroke patients, rehabilitation can help them regain a functional swallow.

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