Swallowing Disorders (Dysphagia)


Dysphagia means difficulty swallowing and can affect people throughout the lifespan. But more often, it impacts older adults who had sustained neurological damage. However, this is not always the case.



Dysphagia is caused primarily by weakness or impairment to one or more nerves or muscles that control sensation and movement for chewing and swallowing. Dysphagia can occur as a result of the following conditions:

  • Stroke: the leading cause of swallowing disorders
  • Neurodegenerative diseases: dementia, Parkinson’s, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or myasthenia gravis
  • Gastrointestinal issues: Gastroesophageal reflux disorder (GERD), bowel obstructions, diverticulitis, inflammation of the esophagus
  • Head and neck cancer: Tongue resections, radiation therapy, etc.
  • Structural and orofacial differences: Cleft/lip and palate, micrognathia, and orofacial-myofunctional disorders
  • Neurodevelopmental conditions: Cerebral palsy and syndromes, such as Down’s, Angelman’s, etc. 


Determining if a client is experiencing dysphagia requires a comprehensive evaluation that reviews the following signs and symptoms:

  • Medical history
  • Coughing, throat clearing, or choking during or right after eating or drinking
  • Wet-sounding voice during or after eating or drinking
  • Extra effort, time, or pain with swallowing
  • Food or liquid leaking from the mouth, getting stuck, or being held in the mouth (often the weaker side)
  • Recurring pneumonia or chest congestion
  • Weight loss or dehydration from not being able to eat or drink enough
  • Increasing difficulty eating independently
  • Inability to contain saliva in the mouth (drooling)

A speech-language pathologist with experience in swallowing disorders can determine if a client is suffering from dysphagia by:

  • Taking a thorough history of the signs, symptoms, and medical condition you are experiencing while
  • Noting any medications you are taking
  • Evaluating the strength, sensation and movement of the lips, tongue, cheeks and larynx
  • Observing a client during a meal, eating different food textures and liquids
  • Determining if there is a need for a modified barium swallow study (MBSS) to observe the muscles under x-ray


Managing dysphagia requires a multidisciplinary approach to ensure the client is able to eat safely and meet their nutritional needs. Therefore, it is critical that all patients who are experiencing varying degrees of dysphagia are consulted with the following professionals:

  • Physician
  • Registered dietitian
  • Occupational therapist
  • Physical therapist
  • Neurologist 
  • Pulmonologist
  • Gastroenterologist

Speech-language pathologists play an integral role in providing therapeutic exercises and strategies to alleviate the risk of aspiration (food/liquids going into the lungs). Treatment may include the following:

  • Modifying the texture of foods and liquids 
    • Diet modifications such as thickening liquids to a nectar-like consistency or pureeing foods can help a person with dysphagia maintain proper nutrition while making it easier to eat and swallow safely
    • Evaluating the safety of more challenging textures (e.g., crackers, rice, certain soups)
  • Modifying the feeding environment
    • Removing distractions
    • Taking small bites or sips within a slow and relaxed mealtime.
    • Using Proper support to keep the person fully upright
    • Presenting food in an attractive manner to make it more appealing
    • Using special utensils, plates, straws, or cups to allow for self-feeding
  • General self-care
    • Keeping the mouth clean and free of bacteria in order to avoid chest infections
    • Staying active with light exercises
  • Rehabilitative exercises
    • Prescribing exercises to strengthen the muscles of the mouth and throat.
  • Compensatory strategies
    • Evaluating whether various body and head positions can minimize risks of choking and/or aspiration

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