Adult Dysphagia (Practice Portal)

Swallowing Support

• What are the signs that food or drink is going the wrong way, and what should I do?

  ✓Supports this

  “A speech pathologist can change food and drink textures, posture and swallowing technique to reduce the risk of things going the wrong way.”

  Sets out these as the swallowing treatments a speech pathologist delivers, with separate sections for diet texture modifications, postural and position techniques, swallowing manoeuvres, and pacing and feeding strategies.

  Treatment of dysphagia may include restoration of normal swallow function (rehabilitative) and/or modifications to diet consistency and patient behavior (compensatory).

  Treatment Approaches and Principles

• What are the signs that food or drink is going the wrong way, and what should I do?

  ✓Supports this

  “Aspiration can happen without any obvious coughing, so it is not always noticeable to the person or the people with them.”

  The speech pathology professional body states plainly that aspiration can be silent, with no outward signs of a swallowing problem. It also lists finding silent aspiration as one of the purposes of an instrumental swallowing test, which is why an assessment can pick up what nobody at the table can see.

  Silent aspiration may be present, meaning the patient presents without overt signs or symptoms of dysphagia.

  Signs and Symptoms

• What can help me eat and drink more safely and comfortably?

  !Qualifies this

  “Changing drink thickness or food texture is an individual clinical decision that should follow a swallowing assessment.”

  The speech pathology professional body warns that texture-modified food and thickened fluids may not remove the risk of aspiration or the pneumonia that can follow, and that thicker liquids are in some cases more likely to be aspirated without any sign of it. So thickening is not automatically the safer option, which is the reason the decision has to be individual.

  In some cases, more viscous materials (i.e., thickened liquids) may be more likely to be silently aspirated (e.g., Miles et al., 2018).

  Diet Texture Modifications

• What is a swallowing assessment, and what does it involve?

  ✓Supports this

  “An instrumental swallowing test is decided by what needs answering, not given automatically. The recognised reasons for one include a chronic degenerative condition with a known progression, and concerns about airway safety.”

  The speech pathology professional body sets out when an instrumental test is indicated. Its list includes concerns about the safety of swallowing, choking and airway safety, a condition carrying a high risk of swallowing problems, and a chronic degenerative condition with a known progression. That describes ALS/MND, so a test is decided by the questions to be answered rather than unusual.

  the presence of a chronic degenerative condition with a known progression

  Instrumental Swallowing Assessment

• What is a swallowing assessment, and what does it involve?

  ✓Supports this

  “An instrumental swallowing test is decided by what needs answering, not given automatically. The recognised reasons for one include a chronic degenerative condition with a known progression, and concerns about airway safety.”

  The same guidance explains why airway safety is one of those reasons: a bedside assessment alone cannot confirm whether someone is aspirating or show how the swallow is working, so where those questions matter an instrumental test is the only way to answer them.

  Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy require instrumental assessment.

  Non-Instrumental Swallowing Assessment