 |
 |
Physician Focus: There's help for swallowing problems By Danielle Morgan-Stevenson GateHouse News Service Posted Nov 17, 2009 @ 01:12 PM The term "swallowing problem" covers many symptoms. More accurately known as "dysphagia," speech language pathologists (aka speech therapists) are involved in the assessment and treatment of swallowing problems, often in collaboration with other medical specialists. But how can one tell if someone has dysphagia? A speech therapist will evaluate the problem in terms of three stages involved in eating and drinking. These are 1) the oral preparatory stage when the food or drink is being prepared in the mouth for swallowing, 2) the oral stage, when the food or drink moves back in the mouth to be swallowed, and 3) the pharyngeal stage, the sequence of actions that move the food or drink from the back of the mouth to the esophagus. There is a fourth stage, the esophageal stage, which takes the food or drink to the stomach. Problems occurring in this stage require medical intervention with a specialist such as a gastroenterologist or other doctor. With an appropriate exam and testing, an ST can decide if your symptom(s) in one or more of the first three stages are abnormal, based upon knowledge of normal function and timing. The ST's primary concerns are two-fold: to change or manage the symptoms to ensure your safety and adequate hydration and nutrition. Dysphagia can occur at any age with many possible causes. Typically this can be due to physical changes or diseases in the nervous system, or in an underdeveloped nervous system in the case of a baby or young child. It may also occur in the anatomy of the head and neck, following reconstructive surgery for cancer. It may be temporary, although intervention remains necessary, or it may be long term. Therapy is entirely customized as there is not a one-size-fits-all treatment. Therapy is based upon accurate diagnosis of your symptoms with the most appropriate management for that combination of symptoms. Often this treatment employs altering food (or liquid) consistency appropriately, using exercises for the mouth and throat, and small postural changes during meal times to alter the anatomy and function during swallowing. The therapist must take into account the person's lifestyle and preferences as eating are an important part or our emotional and social selves. The signs given below could indicate a dysphagia assessment might be helpful. A single symptom may exist or there could be a few symptoms. Consider these if you know someone who might have a swallowing problem: - Most obviously, the person may describe a sensation during eating or swallowing. They might say things like, "I can't get it back, it takes ages to chew, the food gets stuck, I need to clear my throat." It is worth noting there is not always a sensation even when there is a problem. This is particularly true in people with neurological problems, such as a stroke, Parkinson's disease, or multiple sclerosis. - Sometimes coughing or choking during meals or snacks (food or drink). Again, this is not always present. - Speech changes or maybe slight slurring. - Voice changes. They may sound hoarse or gravelly, or weak and quiet, or "wet" or nasal. - Does it take a long time for them to eat a meal (45 minutes or more for just eating/drinking time)? - Congestion as the day progresses, especially in the evening. - Losing weight, although they are not on a diet. - Avoiding some foods or drinks because they anticipate a problem. - Recent medical or surgical event. - Difficulty with swallowing saliva. May drool at times. - Swallowing a few times to get something down. - New difficulty swallowing pills. II you notice one or more of these symptoms, a swallowing evaluation with a speech therapist could be helpful. Remember, most swallowing problems can be helped. Danielle Morgan-Stevenson is a speech pathologist with the Spaulding Outpatient Clinic in Framingham, Mass. Her specialty is dysphagia and disorders of cognition and communication with neurologically impaired people, as well as speech and language disorders in preschool children. Rayilyn Brown Director AZNPF Arizona Chapter National Parkinson Foundation [log in to unmask] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn