Managing dysphagia
The care of a patient with dysphagia involves a multidisciplinary team of specialists. There are different ways to manage dysphagia depending on the underlying diseases and severity of the dysphagia: medical, surgical and/or behaviour management[1].
Medical management
The medical management of dysphagia refers to dietary modifications (e.g special diet, nutrition and hydration regulation or feeding route choice) and/or pharmacologic treatment [1].
Behavior management
Food modifications are among the most widely used behavioural interventions in dysphagia management 1 and are mostly based on altering viscosity of food and liquids in order to :
- Alter the speed at which food passes through the pharynx
- Assist the patient in swallowing
- Reduce the risk of aspiration
- Provide optimum nutrition and hydration
According to the underlying disease and the dysphagia category, the food and drink viscosity recommended varies from one patient to another. A Speech and Language Therapist determines which viscosities and which quantities the patient is able to swallow.
| Example of food and drink viscosity | |
|---|---|
| Food grading | Description of food texture |
| Liquidised / thin puree | Homogenous consistency which does not hold its shape after serving |
| Thick puree / soft and smooth | Thickened homogenous consistency which holds its shape after serving, and does not separate in to liquid and sold components during swallowing |
| Soft / finely minced | Soft diet of cohesive textures requiring some chewing |
| Minced / normal | Normal foods of varying textures which require chewing, avoiding particles of foods which pose a choking hazzard |
| Fluid grading | Description of fluid texture |
Nutricia standards for viscosity (mPa.s measured at 50/s-1) |
|---|---|---|
|
Stage 1 Syrup consistency |
Can be drunk throug a straw Can be drunk from a cup if advised or preferred Leaves a think coat of the back of spoon |
450 +/- 200 mPa.s |
|
Stage 2 Custard consistency |
Cannot be drunk through a straw Can be drunk from a cup Leaves a thick coat on the back of a spoon |
1200 +/- 400 mPa.s |
|
Stage 3 Semi-solid consistency |
Cannot be drunk through a straw Cannot be drunk from a cup Needs to be taken with a spoon |
3000 +/- 1000 mPa.s |
Adequate food and drink texture viscosities can be achieved by using thickener or ready-to-use pre-thickened food and drink. Nutricia offers a complete range of nutritional options in different viscosities stages.
Behaviour management can also refer to swallow rehabilitation and compensation strategies. Exercise programs can help to train specific muscles involved in swallowing. People with swallowing difficulties can also learn new ways to swallow, such as changing the position of their head.
Surgery management
Surgery is also sometimes possible [1].
References
- Groher ME, Bukatman R. The prevalence of swallowing disorders in two teaching hospitals. Dysphagia 1986 1. 3-6.
