Dysphagia management…the role of the speech and language therapist

Guest blog post written by Sandra Robinson, Speech and Language Therapist

This guest blog post was written by independent Speech and Language Therapist Sandra Robinson and owner of Speech Therapy Works. Give her a follow on Twitter @SandraSpeech

Dysphagia is the medical term for a swallow disorder. It’s the medical term for a swallowing problem and is a mixture of Modern Latin and Greek; ‘dys’ means something has gone wrong and ‘phagia’ means ‘to eat’.

It’s a symptom caused in adults by another underlying condition such as a stroke, brain injury, neurodegenerative disease, dementia, head and neck cancer or other cancers, respiratory or gastro problems, mental health difficulties, infection, medications and treatments, and learning disability.

If one or more stages of the swallow are impaired, it can result in choking, chest infections, pneumonia, dehydration, malnutrition and weight loss, psychological deterioration, and ultimately death.

In the UK, speech and language therapists (SLT) play a key role in working with people with dysphagia, to assess the swallow function, and provide therapy in the form of exercises, strategies, manoeuvres, protocols, sensory input, compensatory changes and education.

They work to understand the individual with dysphagia, their medical history and current difficulties, their needs, wishes and preferences. And they work with dietitians to ensure that the person with dysphagia can get the nutrition and hydration they need. All the evidence shows that a multidisciplinary team approach works best, and improves people’s quality of life.

SLTs and dietitians work together in hospitals, in rehab centres, community and clinic services and in private organisations. They often refer people with swallow and/or malnourishment to each other for support.

The SLT’s role is to help assess and manage swallow function, including:

  • advising on the safest consistencies of food and drink using the IDDSI Framework,
  • keep the person with dysphagia and family/carers informed and perhaps provide training on what and how to support safer eating and drinking
  • if the person with dysphagia is at severe risk of choking or pneumonia, they may suggest being nil by mouth and finding other ways to provide nutrition and hydration such as a enteral feeding and/or an intravenous line (IV).

The dietitian will assess for the risk or existence of malnutrition, how to support someone to take enteral feeding, or advise on nutritional support and medically related dietary needs, prevention of skin breakdown or to support healing, education for people with malnutrition and their family/carers, and prevention of weight loss and malnourishment.

Ideally, the SLT and dietitian may see a person with dysphagia together. If this isn’t possible, they will liaise through multidisciplinary team meetings or one to one. This helps to provide more holistic care for the person with dysphagia.  

By working together and with the person with dysphagia and their family/carers, not only can SLTs and dietitians support people to overcome acute episodes of illness but help with rehabilitation, and prevention of possible future issues.

References

Cichero, J.A.Y., Lam, P., Steele, C.M. et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia 32, 293–314 (2017). https://doi.org/10.1007/s00455-016-9758-y

Cynthia J. Heiss, Lyn Goldberg, Marisa Dzarnoski. Registered Dietitians and Speech-Language Pathologists: An Important Partnership in Dysphagia Management, Journal of the American Dietetic Association, Volume 110, Issue 9, 2010, Pages 1290-1293, ISSN 0002-8223, https://doi.org/10.1016/j.jada.2010.07.014

RCLST. Dysphagia Overview. Available at: https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia#section-1 [Online] Last accessed 29 August 2020

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