Eating, drinking and swallowing difficulties

How we can help people with eating, drinking and swallowing difficulties

Some people may not be able to eat, drink and swallow effectively or safely, this is known as an eating, drinking and swallowing difficulty and is also termed dysphagia.

What are eating, drinking and swallowing difficulties?

Eating, drinking and swallowing difficulties occur when an individual cannot pass food or drink safely from their mouth to their stomach. The normal swallow has three phases including:

Oral phase

Where the individual will prepare the food or liquid in the mouth by chewing or sucking for it to be passed into the throat.

Pharyngeal phase

This is where the swallow is initiated, the food or liquid passes through the throat and the airway is closed off in order to protect food or liquid from going down the wrong way.

Oesophageal phase

Is where the relaxing and contracting of the muscles of the feeding tube causes the food or drink to be passed through the oesophagus and into the stomach.

An eating or drinking problem can occur at any of the three stages of the swallow. Eating, drinking and swallowing problems can occur in both children and adults.

Common characteristics of eating, drinking and swallowing difficulties in adults include:

• Coughing or choking when eating or drinking.
• The feeling that food or liquid is stuck or lodged in the lower neck.
• A ‘wet’ or ‘gurgly’ sounding voice when eating and drinking (or just after).
• Holding food or liquid in the mouth for a long period of time without swallowing it.
• Having to clear the throat regularly when eating and drinking.
• Having to swallow several times for one mouthful of food or drink.
• Food or drink falling out of the mouth.
• Tiring easily when eating or drinking

Individuals with eating and drinking difficulties are at higher risk of aspiration (when food goes down into the windpipe) and at an increased risk of chest infections and pneumonia.

What conditions can cause eating, drinking and swallowing difficulties?

Any condition which can cause muscle weakness or nerve damage can result in eating and drinking difficulties. Conditions in adults which can cause eating and drinking difficulties include:

• Neurological problems
• Eating, drinking and swallowing difficulties
• Voice problems
• Speech disorders
• Autism spectrum disorder
• Head and neck cancer
• Palliative care needs
• Physical disabilities
• Learning difficulties
• Mental health problems

How are eating, drinking and swallowing difficulties diagnosed?

Eating, drinking and swallowing difficulties are diagnosed by a medical team of professionals. The speech and language therapist is the main professional who will assess if an individual has an eating drinking or swallowing difficulty. The speech and language therapist will carry out an initial assessment which will include an observation and physical examination of an individual’s eating and drinking abilities. The speech and language therapist may also refer the individual for a videofluoroscopy (a specialist x-ray which looks at an individual’s swallow in more detail). The speech and language therapist will be able to investigate the cause of the eating, drinking and swallowing problem and also what area of the swallow it is affecting.

How can speech and language therapy help with eating, drinking and swallowing difficulties?

Speech and language therapy can support and advise on eating, drinking and swallowing difficulties. The main aim of speech and language therapy for an individual with eating, drinking or swallowing difficulties is for the individual to be eating and drink as safely as possible.

Speech and language therapy input is essential due to the high risk of aspiration in individuals with eating and drinking difficulties.

The speech and language therapist will work closely with a team of medical professionals, the individual and also the individual’s family in ensuring they gain the best outcome regarding their eating, drinking and swallowing needs.

Speech and language therapy will be individualised for each client and will consider factors such as their current and past eating and drinking abilities and also the underlying condition causing their eating, drinking and swallowing difficulties.

In more severe cases of eating, drinking and swallowing difficulties where an individual cannot eat or drink at all, the speech and language therapist and other medical professionals will decide upon the best option of alternative feeding. The individual and their carers will be involved in the decision making process regarding their treatment plan at all times.

What speech and language therapy treatment can benefit eating, drinking and swallowing difficulties?

There are many forms of speech and language therapy which can help and support an individual with eating, drinking and swallowing difficulties. Each treatment plan will be specifically tailored to the individual’s specific eating, drinking and swallowing needs. Types of speech and language therapy treatments that are available for individuals with eating, drinking and communication needs include:

Training

Training involves training for individuals, parents, carers and other professionals involved in the individual’s care, regarding their speech, language and communication needs.

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Consultative role

A consultative role will include advice and support for the individual, their parents, carers and other professionals involved in their care regarding their speech, language and communication needs. The speech and language therapist may also provide information on compensatory strategies for the patient and their carer or parent to help support and maximise their communicative abilities.

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Home programmes

Home programmes will include take home activities, which will help the patient and their parents or carers practise skills learnt in therapy. The speech and language therapist can provide home programmes on communication, for parents, carers and the individual, in helping them to maximise their communicative ability. School programmes can also be given to help support the individual in their educational environment.

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One to one therapy

One to one therapy will provide intensive one to one treatment for the individual. One to one therapy will work on individual tasks in helping to maximise the individual’s communication. One to one therapy can include receptive tasks, which work on the individual’s understanding of spoken language. One to one therapy may also work on expressive tasks, which work on the individual’s expressive communication including gesture and writing.

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Total communication

A total communication approach works on all available communicative forms the patient has including, verbal, written and non-verbal communication.

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Group therapy

Group therapy is where the individual and other clients with similar difficulties receive therapy together. Group therapy can often help in later stages of therapy and increase the individual’s motivation, social skills and also help generalise the skills learnt in one to one therapy.

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Augmentative and Alternative Communication

Augmentative and Alternative Communication systems will be used for patients with severe communication problems, or if the patient is non-verbal. Examples of alternative forms of communication include, alphabet charts, sign language and hi-tech voice aids.

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Speech and language therapy may also include the following:

• Assessments
• Colleges, university and education settings
• Clinic visits
• Home visits
• Reports
• Reviews
• Early intervention

Summary

Eating, drinking and swallowing difficulties occur when an individual is unable to eat and drink food safely. A speech and language therapist will be involved in the assessment and treatment plan of an individual with eating, drinking and swallowing difficulties. The speech and language therapist will aim to have the individual eating and drinking as safely as possible.

If you feel you may benefit from speech and language therapy or would like any more information on our services please email office@slt.co.uk or call 0330 088 5643.