Management of dysphagia

Swallowing rehabilitation involves education of the patient and caregivers in safe swallowing methods, eg. upright posture, chin tucking, and careful slow swallowing; as well as exercises and manoeuvres to achieve an improved swallow, eg. supraglottic swallow. Advice may be sought from a physiotherapist with an occupational therapist advising on seating and utensils. Unfortunately, safe swallowing methods can make eating a slower process. Patients may also be advised not to sleep flat in bed which may prove uncomfortable, and they may still require nutritional support43.

The SLT, or dietician, will advise on a modified diet and the safest food consistencies for the patient in order to reduce or eliminate the risk of aspiration. Often, the most challenging consistencies for a person with dysphagia are thin fluids, such as water, or a mixed consistency, such as solid medication with water. In broad terms the thicker and smoother the consistency the safer it is to swallow; a thicker consistency remaining in a relatively more cohesive state and passing more slowly through the oral cavity and pharynx. However, this will vary between patients so individual assessment is important.

Treatment and management: key points37

  • Despite some encouraging pilot studies, dysphagia remains difficult to treat; safe management is the goal
  • Evidence supports diet modification as the most effective strategy in stroke and Parkinson’s disease patients
  • PEG or NG tubes are not guaranteed to prevent aspiration