Swallowing: Indicators and Management
This Fact Sheet accompanies the Swallowing class in the Techniques for Everyday Tasks classroom.
Swallowing problems may be caused by:
- Illnesses or other medical conditions
- Advancing age
- Neurologic impairments (Parkinsons, MS)
- Stroke
- Dementia or other Cognitive Impairments
- Individuals with dementia related conditions may regress to the ingestive patterns of young children resulting in sucking and suckling
Three aspects to focus for helping with swallowing problems:
- Environment/Ambience
- Identify distractions (visual or auditory)
- Try slow, rhythmic music (turn off if distracting)
- Delineate different food items on the plate
- Tablecloth should be of high contrast with the plates
- Behavior Management
- Use short, clear and precise verbal directives
- One step at a time
- Always use the same term for each specific request
- Demonstrate, touch, assist
- Food Texture and Consistency
- Have individual evaluated by a Speech Therapist or Occupational Therapist to determine what level the swallowing mechanism is functioning
- Texture – regular, diced/mechanical soft, ground, pureed
- Fluids consistency – thin, nectar, honey, pudding
Clinical Symptoms of Swallowing Problems:
- Limited lip or tongue movements
- Wet, gurgly, or hoarse voice
- Drooling
- Excessive chewing or excessive time to finish a normal amount of food
- Breathiness or Shortness of Breath
Clinical Indicators of Aspiration:
- Coughing during mealtime
- Weak or diminished coughing attempts
- Abnormal gagging reflex
- Eyes tearing and increased secretions during mealtime
- Gurgly voice quality
- Significant increase in cardiac rate
- History of unexplained low degree fevers
- Delayed swallowing
- “Different” breathing sounds
- Oral residue after swallowing
What to do?
- Communicate with your doctor or therapist
- Review recommended diet (texture and consistency)
- Suggest an OT or ST consultation
- Suggest a chest x-ray
- Suggest a Videofluoroscopic Swallow Examination (VSE)
- If symptoms are not recognizable, but they are getting recurrent pneumonias, suggest a VSE
Ways to Promote Eating Safely:
- Sit upright, shoulders slightly forward and chin tucked in
- Do not allow head to tilt backward when drinking fluids
- Provide small amounts of fluids or small bites of food on a spoon
- Alternate small bites of food with fluids (check with therapist)
- Introduce empty spoon into mouth to facilitate swallowing
- Check inside mouth to be sure it is empty
- Sit with the person and remind them to chew and swallow
- Provide plenty of time for meals
Special Equipment:
- Special cups fabricated to facilitate drinking without tilting head backwards
- Modified utensils to help self feeding, compensate for movements that may have been lost in the shoulder, forearm, wrist and fingers
- Thickened products are available at your local pharmacy and health section of many grocery stores (Thick-It or Thicken Up)
http://www.simplythick.com/ this is a newer product
http://www.brucemedical.com/ (for “Thick-it” look under “Foods/Beverages” then “Food and beverages thickeners”)
http://www.caregiversmarketplace.com/ (for “Thicken-Up” look under “Medical Nutrition” then “swallowing problems” then “view swallowing problems”)
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