SWALLOWING DISORDERS

& THE ROLE WE CAN PLAY

Carly Ruscello, MS, RDN, LDN

Clinical Dietitian I
Memorial Medical Center
 DYSPHAGIA

• Difficulty or inability to swallow safely and efficiently

• Creates a disturbance in the normal transfer of food
• Swallowing process = four phases
• Lips to stomach
• Important structures involved
• Soft palate, tongue, epiglottis
• The “wrong pipe”
• Trachea leads to lungs
• Aspiration is breathing food and/or
liquids into the airway
 CAUSES

• Cancer of the mouth, throat, neck

• Injury/Trauma
• Stroke
• Neurologic diseases
• Parkinson’s, multiple sclerosis, Alzheimer’s disease
• Cerebral palsy
• Brain injury or tumors

• These lead to less control over muscles the body uses to:
• Initiate swallowing
• Prevent food and liquids from traveling down the throat prematurely
 SYMPTOMS

• Coughing or choking with food or beverage consumption

• Need to swallow repeatedly
• Longer mealtimes than previously
• Drooling
• Minimal or absent gag reflex
• Gurgly voice after swallowing
• Needing verbal prompts to chew or swallow
• Remaining food in cheeks/mouth
• “Lump in throat”
• Unintended weight loss
 CONCERNS

NUTRITION SAFETY

• Inadequate dietary intake • Choking

• Weight loss • Aspiration
• Nutrient deficiencies • Food or drink enters airway

• Protein-energy malnutrition • Upper respiratory infection

• Dehydration • Pneumonia
 DIETS OF SPECIAL CONSISTENCY

• Role of Speech Language Pathologist

• Swallowing evaluation and management recommendations
• Altered foods
• Soft
• Mechanical Soft
• Pureed
• Altered beverages
• Nectar-thick
• Honey-thick
• Pudding-thick
 ALTERED FOODS: SOFT

• Foods that are difficult to chew, sticky, or tough are eliminated for this diet
• YES: tender meats, breads, cold cereal, crackers, soft cheeses, cake and cookies
without nuts
• NO: hard fruits and vegetables, nuts, seeds, corn
 ALTERED FOODS: MECHANICAL SOFT

• Chopped, ground, or blended foods prepared with added liquids

• YES: bread, hot cereal, cold cereal soaked in milk, canned fruit, soft vegetables,
scrambled eggs, ground meats, cooked beans and peas, cottage cheese, yogurt,
custard, pudding, soup, noodles
• NO: tough meats, nuts, seeds, raw fruits and vegetables, dried fruits
 ALTERED FOODS: PUREED

• Smooth, cohesive, pudding-like

• Puree with blender or food processor and strain out any solid foods
• Cook foods until soft and tender before pureeing, utilize appropriate liquids
• Meat: broth, gravy
• Vegetables and starches: milk
• Fruit and dessert: milk, juice
• Serve with extra gravy or sauce
 ALTERED FOODS:
CONSIDER THE SENSES

• Smell
• If the food smells good, it may increase an individual’s appetite and consumption
• Utilize aromatic seasonings: garlic, pepper, onions, cinnamon
• Taste
• Individuals may have a dulled sense of taste
• Taste the altered foods and enhance as needed, being mindful of any special diets
• Sight
• Consider garnishing, swirling, and layering of altered foods
• Mold foods to mimic their shape when regular consistency
 DISTINGUISHING BETWEEN THE
DIFFERENT LIQUID CONSISTENCIES

NECTAR HONEY PUDDING

• Easily pourable
• Consumed from a straw or a
cup
• Comes off spoon in droplets
• Slightly less pourable • Not pourable
• Consumed from a cup or a • Consumed from a spoon
spoon
• Holds its shape
• Comes off spoon in a more
solid stream
• Picture pouring honey
 THE PROCESS TO THICKEN LIQUIDS

• Determine desired consistency

• Follow instructions on container
• Measure out or pump the required amount onto liquid
• Utilize the proper scoop or dry measuring spoons
• Slowly incorporate thickener
• Stir briskly until thickener is dissolved
• Fork or whisk may help break up clumps
• Do not serve hot liquids until liquid is at the proper consistency
 IMPORTANT NOTES

• Impairment level may change

• Food and drink consistencies would need to be adjusted
• Could be increase or decrease in severity of dysphagia

• Look for signs of difficulty

• Act by involving a speech language pathologist

• Ensure consistency of foods and liquids served are safe for the individual
 ADDITIONAL SUGGESTIONS

• Proper positioning
• Sit upright with the head in a chin-down position
• Proper concentration
• Focus on the action of swallowing and on the muscles involved
• Minimize mealtime distractions and conversations
• Allow extra time for meal
 REFERENCES

• Escott-Stump, S. (2012). Nutrition and diagnosis-related care. (7th ed.). Philadelphia,

PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2012). Krause’s food and the
nutrition care process. (13th ed.). St. Louis, MO: Elsevier Saunders.
• Managing dysphagia. (n.d.). Retrieved from
https://www.thickenupclear.com/what-is-dysphagia