Swallowing Therapy Services

Swallowing Therapy Services Goshen NY Eating and drinking are enjoyable social activities shared among family and friends. Most of us don’t think about swallowing while we eat or drink, we just do it. Swallowing is a complex process that involves the coordination of muscles, structures, and physiological processes. When functioning properly, swallowing is a natural reflex that allows us to eat and drink effortlessly. Feeding and swallowing disorders occur when the anatomical features or physiological processes of the swallow are damaged or disrupted. People diagnosed with feeding or swallowing disorders are at risk for nutrition and hydration problems and may also suffer psychological and emotional issues as a result of impaired quality of life. The swallowing process has four phases:
  1. Oral Preparatory Phase: liquid or food (must be chewed) is formed into a rounded mass (also called a bolus) on the tongue in preparation for the remaining phases of the swallowing process.
  2. Oral Phase: the tongue transports the bolus from the front of the mouth to the back of the throat (pharynx) to trigger the swallow reflex.
  3. Pharyngeal Phase: the swallow reflex is triggered, the airway is sealed, and the food or liquid is squeezed down the throat and propelled toward the esophagus.
  4. Esophageal Phase: the food enters and squeezes down the esophagus and into the stomach.
Dysphagia occurs when a person’s ability to eat and drink safely and efficiently is disrupted. Dysphagia may cause a person to experience pain or choking while swallowing, which presents significant concerns regarding safety, nutrition, and hydration. Dysphagia can occur across the lifespan but is most common in adults. Feeding, the act of gathering food into the mouth, is a common problem in children and often leads to nutrition and hydration issues.The most common cause of dysphagia is stroke. Other causes of dysphagia include neurogenic disorders, GERD (gastroesophageal reflux disease), head and neck cancers, and brain or spinal cord injury. Swallowing disorders occur when any phase of the normal swallowing process is disrupted. Patients diagnosed with dysphagia may experience:
  • Coughing or choking before, during, or after swallowing
  • Pain while swallowing
  • Wet or gurgling sound when speaking after eating or drinking
  • Inability to swallow
  • Food getting caught in the throat
  • Less desire to eat or drink
  • More energy or time needed to eat and swallow
  • Food or liquid leaking from the mouth or getting stuck in the mouth
  • Frequent episodes of pneumonia or chest congestion
  • Weight loss or dehydration
Coughing and choking before, during, or after swallowing could be a potential sign of aspiration. Aspiration occurs when food or liquid enters the airway. If aspiration occurs often, there is greater risk for developing aspiration pneumonia . Aspiration may also be silent, meaning there are no visible or audible signs of aspirating. Dysphagia can be evaluated and treated by speech-language pathologists specializing in swallowing disorders. The speech-language pathologist will perform a full evaluation including medical history, current medical conditions, and symptoms and will assess the strength and mobility of the swallowing muscles along with postural and oral movements while eating and drinking. The primary concerns of speech-language pathologists for the treatment of swallowing disorders are safety, hydration, and nutrition. Treatment for dysphagia may include strengthening exercises to improve muscle movement during swallowing, utilizing head or body positions to aid safe and effective swallowing, and prescribing special liquid and food diets (varying in texture, thickness, and size) for safe and efficient swallowing.
Feeding, the act of gathering food into the mouth, is a common problem in children and often leads to nutrition and hydration problems if not addressed. Dysphagia can also occur in children when any part of the normal swallowing process is disrupted.Common causes for feeding and swallowing disorders include neurogenic disorders, gastrointestinal disorders, prematurity and low birth weight, cleft lip or palate, developmental disorders, heart or respiratory conditions, sensory issues, and muscle weakness or abnormalities in the head, face, or neck. Swallowing disorders may also be caused by social, emotional, and environmental issues during mealtime. Children with feeding or swallowing disorders may experience coughing or choking before, during, or after the swallow, difficulty breathing while eating, difficulty chewing, initiating swallow, or managing oral secretions, gagging, vomiting, and prolonged feeding times. Parents and caregivers may notice back arching, skin color changes, crying during mealtimes, frequent congestion or respiratory illness, poor weight gain, and noisy or wet vocal quality during and after feeding. The speech-language pathologist may work collaboratively with a feeding team including a physical therapist, an occupational therapist, a nutritionist, and a developmental specialist. The speech-language pathologist’s primary concerns for children with feeding and swallowing disorders include safety, hydration, and nutrition. Treatment may include increasing tongue movement and the strength of oral muscles, improving sucking, drinking, and chewing ability, tolerating different foods and liquids, altering food textures and liquid thickness to ensure safe swallowing, and coordinating the suck-swallow-breath pattern for infants.
Since the speech-language pathologist (SLP) cannot see what is happening inside the mouth or throat during a typical swallowing test, the SLP may need to perform additional diagnostic tests to view and obtain more information. A common test involves the use of an endoscope, which is a flexible, lighted scope that can be inserted through the nose to view swallowing function. The endoscope is usually attached to a computer or video monitor that allows the test to be recorded for later viewing. This test can be called an Endoscopic Evaluation of Swallowing or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Inserting the endoscope into the nose allows the SLP to view the different parts of the mouth, if food is entering the airway, how certain foods are swallowed, and if specific strategies assist swallowing. Our healthcare professionals are equipped to provide FEES to our patients. Another test involving x-ray equipment may be useful to assess swallowing function. This test is called a Videofluoroscopic Swallowing Study (VFSS), which can also be called a videofluoroscopy, Modified Barium Swallow (MBS) or esophagram.

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