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Management of Dysphagia

Dysphagia Clinics – for people with swallowing difficulties

What does it mean to have dysphagia (or swallowing difficulties)?

Difficulty in swallowing is also known as dysphagia. Dysphagia could result in aspiration, which means food or fluid goes down the "wrong way" and enters the lungs when swallowing. This may lead to chest infections (i.e. aspiration pneumonia) which can be life-threatening.


Who is at risk of having dysphagia?

Dysphagia can occur across age groups and in a range of medical conditions, e.g. neurological diseases (e.g. stroke, Parkinson's Disease and dementia), head and neck cancers (including treatment side-effects from radiotherapy), or general weakness from severe medical events.

Signs of dysphagia include:

  • Coughing, choking, wheezing, gagging or spitting up when eating and drinking
  • Food spilling out of the mouth or lots of food left in the mouth after swallowing
  • Feeling of food stuck in the throat, or
  • Experiencing pain while swallowing


What can Speech Therapists do for people with dysphagia?

Speech Therapists help to assess and manage dysphagia in order to prevent aspiration pneumonia and improve quality of life for people with swallowing problems.

The speech therapist will assess and evaluate swallowing by:

  • Understanding which medical conditions the individual presents with and how they may affect swallowing
  • Assessing the strength and movement of the muscles involved in swallowing
  • Observing posture, feeding behaviour and swallowing movements during eating and drinking
  • If required, perform further assessments to evaluate swallowing, such as
    • Videofluoroscopy (VFS)– an assessment where the swallowing process is viewed on X-ray while the individual eats or drinks food or liquid coated with barium.
    • Flexible endoscopic examination of swallow (FEES) – a flexible scope with a tiny camera is inserted through the nose to observe the swallowing process

Information adapted from ASHA website:


How should I prepare for my swallowing assessment session?

You do not need any special preparations. You should make a list of your swallowing problems ahead of time, the food and liquid textures that you have difficulty with and share it with your speech therapist.


What can I expect during my session?

The session typically takes approximately 30-45 minutes. Your speech therapist will ask questions to get a full understanding of your medical history and presenting symptoms, such as:

  • How your swallowing problems present (e.g. pain on swallowing, or coughing frequently during eating) The types of food or fluids that usually cause these problems
  • How long ago did the swallowing problem start, and how often they happen
  • Other symptoms that might be related to dysphagia, e.g. chest infections, coughing while eating, loss of weight
  • Your medical conditions

Your speech therapist may also speak with your family members for more information about your dysphagia symptoms.

Your speech therapist will perform a bedside swallowing examination, to assess the severity of dysphagia and risk of aspiration. This is a simple clinical assessment that does not need any special preparations or precautions. The speech therapist will examine your swallowing function, by observing how you swallow different food textures and drinks. 

Your speech therapist may recommend a VFS or FEES procedure to examine your swallowing function in further detail, if you need it. 

How will speech therapists help to treat my dysphagia?

Treatment depends on the cause, symptoms, and nature of the swallowing problem. After the assessment, your speech therapist will discuss the recommendations with you. Suggestions for safer swallowing include:

  • modifying your diet / fluid textures to make it easier and safer to swallow
  • using certain compensatory strategies or posture modifications
  • teaching specific rehabilitation exercises to improve muscle movement

How can I get an appointment to see the Speech Therapist?

You will require a referral letter from a Singapore-registered medical doctor, made out to Speech Therapy.

Please call SGH Central Appointment's Hotline at 63214377 to make an appointment to see a Speech Therapist.


Specialised Rehabilitation Clinic - Device Assisted Rehabilitation of Swallow (DARS)

The DARS clinic is a specialized clinic, where biofeedback tools are utilised to aid rehabilitation of dysphagia.

During your rehabilitation process, your speech therapist will explain about your swallowing presentation and discuss your goals for therapy. The extent of recovery expected for your condition will also be discussed. Depending on your swallowing presentation and severity of dysphagia, your speech therapist will prescribe a series of rehabilitation exercises that is personalized for your condition.

The DARS clinic uses devices such as the Iowa Oral Performance Instrument (IOPI) and Surface electromyography (sEMG) to help to rehabilitate speech or swallow function. These devices are used to provide online biofeedback, and is useful for monitoring your performance in doing specific rehabilitation exercises. You can also monitor your own rehabilitation progress and develop control over the corresponding swallowing functions.

The clinic also strives to incorporate new research findings in dysphagia management into the rehabilitation process.


How long will the treatment process take?

Each session typically runs for 1 hour. Initially, your speech therapist will suggest a block of intensive weekly visits until you can do the exercises accurately on your own. The frequency of session vary, depending on your needs and progress.