Helping people visualize how the swallow works is the first step in meaningful dysphagia therapy. The swallow mechanism itself is incredibly complex, using over 30 nerves and muscles (or more, depending on who you ask). It’s an interwoven dance with several key elements that can break down along the way.
Before starting dysphagia therapy, ask your patients: “What has anyone told you about your swallowing disorder? What can you tell me about it?” This will give you a starting point and will begin the long dialogue that will help tease out what the person needs and wants from therapy.
From there, use the following resources to pin-point the individual needs of each patient.
Resources for clinicians
Speech Uncensored podcast episode: Replacing a language of fear for facts when discussing dysphagia management with Will Farnham, MS, CCC-SLP
You likely know Will better by his social media handle @hardtoswallowslp. But he’s got so much more to share than hilariously relevant medical SLP memes. Will’s got a bit of a soapbox moment that he needs to broadcast. Okay, I asked him to broadcast it because I 100% agree with his sentiments and I want to learn more.
So check out the episode as Will breaks down how replace a language of fear with one of facts when discussing dysphagia management with your patients.
Be sure to check out the show notes for links to excellent resources to read!
An app that will help you visualize the swallow as assist in making clinical decisions based on swallow impairments.
Designed for speech-language pathologists working with patients experiencing dysphagia, this two-page guide augments clinical decision making with a pathway for which swallow strategies to choose based on clinical observation. While this is not a black and white answer key to the many unique cases of dysphagia, it is a starting point to consider when working through each case.
Dysphagia Clues from H&Ps: A Guide for Speech-Language Pathologists
This two-page guide outlines how to detect clues from a patient's H&P in order to accurately diagnose dysphagia etiology and treatment plans.
This quick reference guide refers to common medications that may cause dysphagia. This reference is limited in scope and is not a comprehensive list of every drug that may cause difficulty swallowing. Medications available on the current market may have changed since this documented was created. It is best to gain a general understanding of the classes of drugs that may cause dysphagia and refer to physicians to discuss care plans.
Does aspiration = pneumonia? Maybe. This handout is designed to help Speech-Language Pathologists navigate this complex conversation with patients who are at risk of dysphagia. The handout breaks down the evidence base of three variables and how they stack up to different risks. This provides a clear visual as to how a healthy immune system and quality, consistent oral care may be a strong avenue to prevent aspiration pneumonia, even in the presence of aspiration risk.
Differential Diagnosis: Presbyphagia
This handout is designed for speech-language pathologists performing differential diagnosis assessments for disease-related swallow impairments vs age-related swallow impairments. The handout describes the oral and motor symptomatic differences for accurate differential diagnosis.
Resources to help visualize the swallow
Visualization of swallow anatomy/physiology for speech-language pathologists targeting dysphagia. Resource for SLPs, patients, and medical/therapy staff.
Handout for speech-language pathologists that defines the 5 most important cranial nerves as related to swallowing problems.
Resources for the psychological impact of dysphagia
Swallow: A Documentary
This video by the National Foundation of Swallowing Disorders is stunning. It shares the stories of multiple people impacted by dysphagia, with multiple ages and etiologies. At only 15 minutes, it’s a powerful educational tool that you can use inside of your therapy session. The photography is hauntingly beautiful and people experiencing dysphagia will appreciate the human connection found in the documentary.
A list compiled by the National Foundation of Swallowing Disorders- they also host Facebook groups that help people connect to support groups around the world.
Having dysphagia can make it difficult to eat out a restaurants or other people’s homes; however, this shouldn’t keep patients and their families from doing so. Mealtime is a significant part of the day for social interaction with family and friends This handout contains some ideas and tips to consider so that eating out can continue to be an enjoyable part of life.
Head/neck cancer and surgery resources
This handout is designed for rehabilitation therapists working with patients who are experiencing radiation fibrosis syndrome after undergoing radiation treatment. The handout describes the physiological changes that result in this condition and provides specific information about how radiation fibrosis syndrome can affect the swallow muscles following radiation treatment for head/neck cancer. The handout encourages those seeking radiation treatment services to seek the services of a speech-language pathologist to begin dysphagia therapy before, during, and after radiation treatment, as research has shown that this reduces the risk of chronic dysphagia (see sources on handout).
Recent research into the effects of dysphagia therapy for patients undergoing head and neck cancer treatment have provided new insights into the importance of proactive swallowing therapy.
This handout is designed for Speech-Language Pathologist working with people who are on relatively long-term NPO status while recovering from other health impairments. The handout describes recent research outlining benefits of proactive swallowing therapy to prevent dysphagia and describes the basic anatomy/physiology of the swallow as well as the risk of aspiration and aspiration pneumonia.
Handout for people coping with the loss of taste after surviving a brain injury or undergoing radiation treatment for head and neck cancer.
It’s difficult to find statistics for the number of Americans who suffer from anosmia and/or ageusia. Generally, the accepted number hovers around 2 million cases, however a study by Claire Murphy, psychology professor at San Diego State University puts it closer to 14 million.
Whatever the statistics are, I’m sure they are high at your facility. Strokes, brain injuries, aging, cancer treatments, neurological diagnoses, all can lead to the loss of the sense of taste and/or smell. And this loss is devastating.
Research into anosmia and ageusia is limited. Research by Professor Thomas Hummel, who runs the Smell and Taste Clinic at the University of Dresden in Germany, found that smelling certain strong odors - including rose oil, lemon and cloves - repeatedly over a 12-week period resulted in some improvement in olfactory function. Researchers continue to learn more and more, but it is a slow and tedious process, leaving us to rely on the usual tips and tricks of the trade to improve the sensation of taste- using temperatures, colors, and textures to make food more enjoyable. Currently, we have no clinical options as SLPs to ultimately repair and drastically improve taste and thus help prevent the unintentional weight loss and depression that stems from these afflictions.
This handout is designed for rehabilitation therapists working with patients who are experiencing dysphagia while they are recovering from anterior spine surgery. The handout is two pages and features three major culprits that cause dysphagia as well as treatment options and details about how damage to different cervical spine discs will present in the context of dysphagia.
Resources for staff communication and education about dysphagia
This form is designed for speech-language pathologists in medical settings needing to communicate aspiration precautions to nursing, physician, therapy, and kitchen staff. The form is designed to specify the following:
- Name, room number, date
- New admit, re-admit, diet change, or variance form in place
- Diet texture
- Liquid consistency
- How to give medications
- Level of supervision
- Supervision personel
- Oral care instructions
- Swallow precautions, including check boxes for 17 common strategies and room to write individualized strategies
- Where meal trays should be delivered
- Adaptive gear
- Places for SLP and physician signatures
This form may replace a variety of different forms within a facility and improve workflow and productivity.
These handy dysphagia cue cards are designed to be discretely placed at dining tables to remind patients of dysphagia precautions. The cue cards feature a graphic of swallow anatomy/physiology and have blank spaces for SLPs to include specific personalized swallow strategies.
This 5-page handout is designed to assist speech-language pathologists with staff education and training around dysphagia knowledge and precautions. The handout includes information about:
- Dysphagia risks
- The qualifications and role of the SLP
- Aspiration risks
- Red flags of dysphagia
- Strategies SLPs use to reduce risks
- Basic swallow anatomy
- Strategies nurses and CNAs can use to help people with dysphagia
- How to prepare thickened liquids with instructions for powder thickeners and gel thickeners
- Signs and symptoms of dysphagia by common diagnoses
- The importance of oral care
- The risk of aspiration pneumonia in the context of oral care, aspiration risk, and auto-immune status
This handout is designed for rehabilitation therapists working with patients, staff, family, and caregivers to ensure best practices when it comes to general aspiration precautions in the context of dysphagia. Many of these straight-forward strategies are frequently overlooked; this visual is meant to provide a visual reminder for everyone involved in the care and safety of someone experiencing dysphagia. Note that these are general precautions and are not meant to target any one particular dysphagia diagnosis. Specific strategies will need to be added for individual cases.
This resource is designed for rehabilitation therapists working with staff to ensure quality patient care when it comes to aspiration precautions. These four cue cards are designed to remind staff to follow aspiration precautions. The first card reminds staff to complete oral care before serving a meal. The second reminds staff to complete oral care after meals. The third card reminds staff to put dentures in before a meal. The fourth cue card reminds staff to assist with oral care before bed.
Handout featuring explanation of aspiration pneumonia as related to GERD as well as 8 specific strategies for reducing the symptoms of GERD and related risk of aspiration pneumonia. Designed for speech-language pathologists working with patients who have dysphagia exacerbated by GERD.
This visual quick guide to reflux is designed for speech-language pathologists who work with patients experiencing dysphagia possibly related to reflux.
Reflux and the role of the speech-language pathologist
Do you work with people who often exhibit burping, heartburn, or regurgitation during a swallow study? Do they report feeling full before they finish their meal, or that something is stuck in their throat?
30% of patients with oropharyngeal dysphagia also have an esophageal pathology (Belafsky et al, 2008). If you work with people experiencing dysphagia, most likely you have come across complications with reflux. Incidence is on the rise, particularly due to changes in FDA policies requiring higher standards of food preservation that resulted in acidification of bottled and canned foods in the 1970s. Esophageal cancer is the fastest growing cancer in the United States with a prevalence increasing 850% since 1975 (Kaufman et al, 2014).
The speech-language pathologist is in a unique position to gather details of case history, conduct a medication review, observe of functional impairments, evaluate of voice, swallow, and oro-pharyngeal function before referring to GI or ENT. SLPs can also offer reflux counseling in a therapeutic setting.
This quick reference guide is packed with statistics meant to arm you with information needed to establish a complete picture of a patient struggling with both dysphagia and reflux.
How low should an SLP go? What exactly is our role when it comes to esophageal dysfunction? This material describes a speech-language pathologist’s role in screening for/being a part of a multidisciplinary team to treat esophageal dysphagia. Includes a handy quick reference chart for comparing and contrasting the symptoms of each etiology of dysphagia.
Oral care resources
Handout designed for Speech-Language Pathologists to provide to staff, patients, and family to help communicate the importance of oral care to prevent aspiration pneumonia.
Oral care is frequently overlooked in hospital, rehabilitation, and long-term care settings. This handout describes step-by-step instructions for completing oral care, with specific care instructions for people who have dentures or who are at high risk for aspiration. This handout is designed for staff, patients, family, and caregivers to improve the quality of oral care and reducing the risks associated with oral bacteria in the body.
Oral care continues to be one of the most powerful preventative cares in rehabilitation and long-term care settings. This handout describes the latest research showing the effect that oral care can have on overall health, including brain function, heart longevity, and diabetes management.
This handout is designed for speech-language pathologists working with adults in medical/rehabilitation settings who are experiencing Candidiasis, or oral thrush. The handout describes the causes, signs/symptoms, treatment, and prevention guidelines, with an emphasis on proper oral care.
Thickened Liquids Education and Resources
This handout is designed for Speech-Language Pathologists who work with people who have dysphagia and use thickened liquids as a compensatory strategy due to a delayed swallow.
This handout is designed for patients, caregivers, and staff to illustrate where "hidden" thin liquids may pose a risk for people with dysphagia on thickened liquids. While not a comprehensive list, this handout highlights ice, straws, frozen treats, soup, and saliva, laying out the reasons why these things may pose an increased risk of aspiration and offering alternative solutions to reduce this risk.
Hydration is a persistent challenge for patients who are NPO. This handout describes the Free Water Protocol, established in 1984 at the Frazier Rehab Institute. The handout describes the risks, benefits, and guidelines around the protocol and is appropriate for staff, patients, families, caregivers, and therapists.
This handout is designed for speech-language pathologists working with patients who have dysphagia and are using thickened liquids as a compensatory strategy. The handout lays out the basics of these types of thickeners, including main ingredients, shelf life, how they're thickened, and pros/cons.
- Powder-based thickeners
- Pre-thickened products
- Gel-based thickeners
- Natural thickeners
These three signs are designed for Speech-Language Pathologists to improve carry-over of thickened liquids as a compensatory strategy. Signs placed at head-of-bed can serve as helpful reminders for patients, staff, and family.
Diet Texture Resources
Handout designed for Speech-Language Pathologists to share with patients, family, staff, and kitchen managers to describe the texture and benefits of meltable solids for people who have dysphagia, particularly people who are usually on pureed diets but still have the ability to chew.
Being on a pureed diet can be an isolating, degrading, depressing situation. This calls for creativity! There are so many ways to add flavor to mashed potatoes- make it a dessert, make it spicy, make it Thai, Indian, Mexican cuisine... there are no limits! Here are 27 ideas to get kitchen staff, patients, and families inspired.
Are your patients on dysphagia diets sick of applesauce, pudding, and yogurt? Smoothies offer an enormous range of options to improve taste and nutrition for people who are on altered textured diets. This 3-page visual handout offers specific smoothie ingredient options to improve intake of proteins, fats, vitamins, minerals, fiber, and to improve digestive and overall health. This handout is most appropriate for speech-language pathologists and dieticians working within the context of a rehabilitation team addressing the unique needs of people with dysphagia.
Swallow Exercises and Strategies
Designed for Speech-Language Pathologists working with patients who have dysphagia and need to strengthen the suprahyoid muscles to improve the swallow.
This handout is designed for speech-language pathologists working with patients and interdisciplinary medical team members to make complex medical decisions related to alternative nutrition and hydration. The handout is designed to provide information to SLPs, doctors, nurses, nutritionists, patients, family members, and caregivers. The handout describes the different types of alternative nutrition and hydration methods (PEG vs NG), visualizes the team of people involved in making this decision, and includes two pages of tables packed with evidence-based information about the prognosis, quality of life, risk of aspiration pneumonia, and possibility of curative therapy enabled by alternative nutrition and hydration, organized by major diagnoses. This handout is not meant to be a black/white or yes/no flowchart for this decision. Rather, it provides a broad picture of the evidence base and encourages the decision to be made as a team considering all of the pros and cons of each option.