Feb. 25, 2000 (San Antonio) Drinking a tall, cool glass of water is something most of us take for granted, but for the 500,000 Americans who suffer from dysphagia, or difficulty swallowing because of injury, disease, or an inherited condition, the act can be painful or even impossible.
Richard Senelick, MD, medical director of HealthSouth Rehabilitation Institute of San Antonio, says that dysphagia due to brain, brainstem, and peripheral nerve disease is more common than from muscular disorders, such as myasthenia gravis or scleroderma. "Strokes and brain injuries account for the majority of swallowing problems, including impaired tongue movement and muscle weakness in the throat, esophagus, and face. Losing the ability to swallow normally can increase the risks of malnutrition and dehydration, and choking on food or vomit in the airway can lead to potentially fatal aspiration pneumonia."
Patients who suffer from neurological and muscular disorders typically see neurologists, internists, and gastroenterologists, but they rarely make it to a rehabilitation specialist for swallowing therapy, Senelick says. "A trained therapist can learn a great deal of information by observing a patient swallow various consistencies of solids and liquids. He or she will notice whether patients pocket food in their cheeks due to weak muscles or loss of sensation, or if their lips cannot properly close around food."
The American Academy of Otolaryngology - Head and Neck Surgery suggests that caregivers and primary care physicians who suspect that a patient or loved one is having difficulty swallowing be on alert for the following signs:
Poor-fitting dentures, gastroesophageal reflux, sore throats, and a common cold may cause temporary swallowing problems, but if dysphagia continues, medication, surgery, or rehabilitation will likely be required.
About 90% of the speech-language pathologists who work in health care and belong to the American Speech-Language Hearing Association (ASHA) provide evaluation and treatment for people with swallowing problems. ASHA maintains a directory of certified speech-language pathologists in every state (www.asha.org) they may be contacted directly at 1-800-638-TALK or emailed at actioncenter@asha.org.
Changing diets, adjusting posture, and encouraging patients to perform facial exercises, such as broad smiling, frowning, or opening and closing the lips, as well as tongue exercises -- licking a lollipop, for example -- can stimulate them to swallow more effectively. Trained therapists can instruct patients and their families about techniques to compensate for individual obstacles and to prevent choking.
Although dysphagia occurs in all age groups, swallowing disorders in the elderly are expected to increase dramatically as the largest generation in history slips into retirement age prompting a real need for specialized swallow therapists.