Dysphagia Essay

Introduction to Dysphagia

Dysphagia is a significant and often life-threatening impairment that affects an individual’s ability to swallow safely. It occurs secondary to other primary medical and neurological diagnoses, such as stroke, traumatic brain injury, Parkinson’s disease, and myasthenia gravis (Groher & Crary, 2010). Epidemiological data indicate that as high as 10 million people per year are evaluated for dysphagia (Domench & Kelly, 1999; ASHA, 2008), and the prevalence of dysphagia is upwards of 22% in persons 50 years of age and older (Howden, 2004; ASHA, 2008).

Dysphagia is characterized by impairment to any of the four stages involved in swallowing: oral preparation phase, oral phase, pharyngeal phase, or esophageal phase (Groher & Crary, 2010). Identification and diagnosis of specific swallowing impairments involve obtaining objective information using videofluoroscopic procedures, such as the videofluoroscopic swallow study (VFSS) which has been used in practice since the 1970s (Cook & Kahrilas, 1999) or the fiberoptic endoscopic evaluation of swallowing (FEES) which is a relatively new assessment procedure since the early 1990s (Langmore, Schatz & Olson, 1991; Groher & Crary, 2010).

Treatment Overview for Dysphagia

Depending on the specific physiological processes that are impaired, such impairments will determine the goals and possible course of treatment. Therapeutic modalities may be compensatory or rehabilitative in nature, and include providing direct treatment to the swallowing mechanism by using food during treatment or indirectly providing treatment by performing range of motion and strengthening exercises (Logemann, 1998), as well as other techniques that facilitate to improve stimulation of the swallow. ...

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... the research that has been conducted has both supported and refuted the effectiveness of using thermal-tactile stimulation as a treatment strategy for a delay in swallow initiation or improving swallowing physiology. Positive results have been documented, including a decrease in the delay in swallow initiation and pharyngeal transit time, a reduction in pre-swallow pooling, and a reduction in the incidence of laryngeal penetration and aspiration. However, insignificant results have also been documented, such as no or inconsequential effects on the swallowing initiation reflex, oral and pharyngeal transit times, and upper esophageal sphincter opening. The mixed nature of these results lends the clinician to administer this type of treatment with caution, until more well-designed, empirically-based, and peer-reviewed studies consistently demonstrate positive results.