(Swallowing Difficulties)
What it is
An impairment affecting swallowing muscle strength, sensory awareness, or physiological coordination across the oral and pharyngeal phases of swallowing, commonly caused by neurological damage to the brain (including the cerebral cortex, subcortical structures, and brainstem) or cranial nerves.
Clinical Characteristics
- Frequent coughing or choking during oral intake
- Pocketing of food in the cheek
- Delayed or absent pharyngeal swallow trigger
- Wet or gurgly vocal quality
- Compromised airway protection
- Silent aspiration due to reduced sensory awareness
Common causes
- Stroke
- Neurodegenerative conditions, such as Parkinson’s disease and multiple sclerosis
- Dementia
- Head and neck cancer and its treatment
- Age-related changes in swallowing
Why it matters
Untreated swallowing difficulties can lead to chest infections (aspiration pneumonia), dehydration and malnutrition. They can also affect quality of life and cause anxiety and low mood.
What a swallowing assessment covers
- Whether eating by mouth is safe, or tube feeding (NGT or PEG) is needed
- The right food textures and drink thickness
- Caregiver training: preparing modified food and drinks, and reducing the risk of chest infections
- Whether an instrumental assessment (FEES or videofluoroscopy) would help
- Referral to other specialists where needed
What therapy can do
- Neuromuscular Rehabilitation: Targeted exercises to help strengthen the muscles used for swallowing, such as Chin Tuck Against Resistance (CTAR), the Shaker exercise, the Masako manoeuvre and Expiratory Muscle Strength Training (EMST).
- Sensory Stimulation & Interventions: Sensory stimulation approaches to help improve the throat’s awareness of food and liquids, together with clinical swallow examinations to guide suitable fluid consistencies (IDDSI levels) and food textures, which can help reduce the risk of aspiration pneumonia.
- Compensatory Strategies: Training patients and caregivers in specific postural adjustments (e.g. chin-tuck, head-turn) to support safer, more comfortable and more independent oral intake.
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