Dysphagia and Aspiration

Dysphagia and Aspiration

Dysphagia is a prevalent clinical condition that often leads to complications such as malnutrition and aspiration pneumonia. The term describes either the difficulty experienced during the initial swallowing or the sensation of food obstruction. An understanding of dysphagia, its assessment and the interventions that can prevent aspiration is critical to the delivery of effective care.

According to ASHA (2018), dysphagia is accessed using either the instrumental and non-instrumental approach. The instrumental assessment is performed by either a Speech-Language Pathologist (SLP) or the SLP and other members of the inter-professional team. On the other hand, the non-instrumental assessment is primarily performed by the SLP. The instrumental assessment uses two main techniques to assess abnormal swallowing. These techniques are FEES and VFSS. In a typical case, only one of the two methods is used. The assessment entails the evaluation of the patient’s oral, respiratory, laryngeal, upper esophageal and pharyngeal functions (Hoffmann, Bennett & Mar, 2013). The SLP guides the implementation of the appropriate procedures. The pathologist also interprets and implements the assessment results. On the other hand, the non-instrumental method involves observing the patients’ swallowing behavior. This method entails oral, speech and vocal quality examination and the evaluation of the respiratory rate, swallowing pattern and ability to clear the airway.

VFSS and FEES are fundamental in the patient’s evaluation and formulation of strategies to prevent aspiration. The preventive strategy involves the modification of food texture and positioning techniques such as head rotation to facilitate swallowing. In the case of a hand-fed patient, prevention is attained through proper posture during feeding, alternating solid and liquid boluses, minimizing the use of sedatives and applying a tolerable rate of feeding (Saitoh, Pongpipatpaiboon, Inamoto, & Kagaya, 2017). Similarly, aspiration can be prevented during tube feeding through measures such as identifying the signs of intolerance, keeping the bed’s backrest elevated and regular monitoring of the feeding tube.

Conclusion

The SLP can assess dysphagia using either non-instrumental or instrumental approaches. Corrective interventions such as positioning, food modification and bed elevation reduce the risks of aspiration in patients with dysphagia.