Swallowing Therapy & Dysphagia Diagnostics

Difficulty swallowing (dysphagia) can result from a number of causes including stroke or brain injury, head and neck cancer, trauma, and neurodegenerative conditions. This can result in avoidance of your favorite foods and drinks as well as other medical effects including weight loss, dehydration, malnutrition, and pneumonia.

An instrumental evaluation of swallowing (MBSS or FEES) is needed to identify the cause of the dysphahgia and determine the best approach for treatment.

A swallowing evaluation is recommended if you are experiencing any of these symptoms.

 

  • Difficulty swallowing solids, liquids, or pills

  • Coughing during or after eating and drinking

  • Increased effort in chewing or swallowing

  • Prolonged meal times

  • Recurrent pneumonia

  • Sensation of food getting “stuck”

  • Shortness of breath while eating and drinking

  • Foods/liquids spilling out of the mouth or nose

  • Changes in eating habits

  • Weak cough

  • You need an instrumental swallow evaluation or second opinion

How We Can Help

Clinical Swallow Evaluation: A clinical swallow evaluation is the first step when there is suspected swallowing difficulty. A thorough case history, interview, and swallowing-related tasks allow us to determine if there is a swallowing issue, refer for further instrumental assessment, form a hypothesis of possible impairment, assess how swallowing issues are affecting your quality of life, and identify your goals for therapy.

Instrumental Swallow Evaluation: Instrumental swallow evaluations including modified barium swallow studies (MBSS) and flexible endoscopic evaluation of swallowing (FEES) are gold standard swallow evaluations. MBSS and FEES allow visualization of the swallowing mechanism to determine the impairments contributing to swallowing difficulty, formulate an individualized treatment program to address these impairments, and make recommendations for temporary diet modifications and compensatory strategies as needed.

Treatment: Treatment of swallowing disorders can consist of a targeted exercise program for the deficits identified on the instrumental swallow evaluation to improve swallowing function and airway protection, use of postural adjustments, adaptive equipment, and compensatory strategies, and potential temporary diet modifications. We are proud to offer evidence-based swallowing treatments grounded in the principles of exercise science, including intensive swallowing treatment programs, with state-of-the-art equipment.

Certifications and Training

 

McNeill Dysphagia Therapy Program (MDTP)

MDTP is a specialized exercise-based swallowing rehabilitation program to improve swallowing function by incorporating the principles of exercise science. Focus is placed on restoring a more normal swallowing pattern by using food and liquids as exercise. This is an intensive swallowing program requiring a minimumm of 3 session per week.

 

Manual Therapy for Voice & Swallowing

Manual therapy, also referred to as Myofascial release (MFR) is a form of manual therapy focusing on the incorporation of gentle and sustained pressure to increase range of motion and reduce pain. Though commonly used by physical therapists, MFR has applications for persons receiving speech, voice, or dysphagia therapy. This is a person-centered approach which emphasizes feedback and direction from the client. In swallowing therapy, this approach is most beneficial for those with dysphagia secondary to excess muscle tension or post-treatment for head & neck cancer.

Ampcare Effective Swallowing Protocol (ESP)

Ampcare is a modality for treating swallowing through the use of neuromuscular electrical stimulation (NMES). Through NMES, the muscle fibers required for swallowing can be more efficiently targeted to improve swallowing function. Compared to other forms of electrical stimulation, Ampcare has a strong evidence base and is more grounded in the principles of exercise science and exercise physiology to more efficiently improve swallowing function compared to other NMES programs.

 

Respiratory Muscle Strength Training

RMST, or respiratory muscle strength training, is a treatment modality becoming widely used in the field of speech-language pathology for patients with impairments in speech, voice, ventilation, cough, and swallowing. RMST involves using resistance or pressure threshold devices to strengthen either the muscles of inspiration (breathing in) or expiration (breathing out). In swallowing therapy, RMST is useful to increase cough strength for airway protection, engage the muscles used to elevate and protect the airway, and has implications for reducing nasal regurgitation.

Flexible Endoscopic Evaluation of Swallowing (FEES)

FEES is a gold standard instrumental assessment of swallowing function. FEES involves using a thin flexible tube attached to a light source to allow visualization of the structues of the nose, pharynx (throat), and larynx (voice box). This assessment is used to identify the anatomy or physiology contributing to swallowing issues to develop an individualized treatment plan to improve swallowing and identify any needed compensatory strategies or postural adjustments. FEES can also be used as a adjunct to therapy as biofeedback to ensure accurate completion of swallowing exercises.

sEMG Biofeedback

Surface electromyography (sEMG) is a treatment modality involving placement on electrodes under the chin to electronically display muscle activity during the completion of swallowing exercises. Research has shown that using sEMG while completing swallowing exercises can help to increase accuracy and and promote increased muscle effort.