In this short article we list different types of dysphagia treatment and management and briefly describe one of the most common ways to manage dysphagia.
Dysphagia Treatment and Management
There are no medicines to cure dysphagia but there are several types of dysphagia treatment and management:
Rehabilitative exercises
e.g. chin tuck against resistance, shaker, masako and lip and tongue exercises.
Postural swallow strategies
e.g. chin tuck, head back, head turn to the affected side, head tilt to the unaffected side, lying down head supported.
Compensatory swallow techniques
e.g. Mendelsohn manoeuvre, supraglottic swallow, supersupraglottic swallow, effortful swallow.
The optimisation of current swallow abilities
e.g. modifying the environment to remove distractions, providing stimulating or calming music, sensory integration techniques, ensure spectacles, hearing aid and dentures are in place.
Indirect approaches
e.g. training others to support the individual with dysphagia, provide objects of reference, optimise body posture and tone, food placement in the mouth, slow pace of eating, verbal prompts, providing specialist utensils and crockery.
Modifying the sensory characteristics of food and drink
e.g. altering volume, providing different tastes, providing sour or carbonated oral intake, making food softer and making drinks thicker.
Modifying the texture of food and drink is often referred to as a “dysphagia diet” and is perhaps the most common dysphagia treatment so we will concentrate on this management method in the rest of this article.
One of the most common ways to manage dysphagia
Texture modified dysphagia diets can maximise health and well-being, minimise the risk of malnutrition and dehydration, minimise the risk of aspiration pneumonia and maintain oral nutrition. Maintaining oral nutrition avoids the need to feed people with dysphagia through a tube which is expensive and unpleasant for the individual.
A person with dysphagia may not be able to cope with chewing and swallowing solid food but may be able to cope with soft, pureed food. Similarly, a person with a swallowing disorder may not be able to cope with swallowing “thin” liquids but may be able to cope if their drink is thickened.
If someone has dysphagia, thin liquids may go down their trachea into their lungs rather than down their oesophagus into their stomach. This is called aspiration. It is unpleasant and can lead to choking, pneumonia and even death.
Thickening drinks is an effective dysphagia treatment and management method because it makes the bolus more cohesive. This may make it easier for someone who has dysphagia to swallow their drink safely without aspirating.
Powdered starch or gum is mixed in to drinks to make them thicker. There are several different manufacturers of these thickening agents.
Thickening drinks can reduce the risk of aspiration but different people require different thicknesses. Drinks that are too thick can increase the risk of post-swallow residue remaining in the throat which may then be aspirated.
Also, drinks that are too thick tend to be unpalatable and can be left un-drunk, or make someone feel satiated before they really are, leading to dehydration. Furthermore, the thickener can impede the digestion of medicines.
Because of this, it’s important to provide drinks of the correct consistency for each individual: not too thin and not too thick.
In fact, thickening drinks to the correct consistency to reduce the risk of aspiration is part of the Intercollegiate Stroke Working Party National Clinical Guidelines for Stroke1 and the NICE care pathways where dysphagia is a symptom.2,3
Although thickening drinks is commonly used to treat and manage dysphagia, as explained in our next article, there are problems with thickened drinks.
Do you have experience of other treatments / management methods for dysphagia? Do you use thickened drinks? Please feel free to leave a response below.
References
- Intercollegiate Stroke Working Party National Guidelines For Stroke, 5th Edition. London: Royal College of Physicians, 2016
- National Institute for Health and Care Excellence (NICE) Clinical Guideline [CG68] Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, 2008
- National Institute for Health and Care Excellence (NICE) Clinical Guideline [CG42] Dementia: supporting people with dementia and their carers in health and social care, 2006