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 difficulties.
The assessment can include:
Understanding what 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: https://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/
General Swallow Clinic
What can I expect during my session?
The session typically takes approximately 30-45 minutes. Some questions about your medical history and presenting symptoms will be asked to obtain a full understanding of your difficulites. These may include:
How your swallowing problems may present (e.g. sensation of pain during swallowing, coughing frequently during eating)
The types of food or fluids that usually cause these swallowing problems
Duration of swallowing difficulties and how often do they happen
Other symptoms that may be related to dysphagia, e.g. chest infections, coughing while eating, loss of weight
Your medical conditions
We suggest that you make a list of your swallowing difficulties, the food and liquid textures that you have difficulty with ahead of time.
Your therapist may also speak to your family members for more information about your dysphagia symptoms.
A swallowing examination will also be performed, to assess your swallowing function, severity of dysphagia and risks of aspiration. This is a simple clinical assessment that does not need any special preparations or precautions.
A videofluoroscopy (VFS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES) may be recommended to examine your swallowing function in further detail, if necessary.
How will Speech Therapists help to treat my dysphagia?
The treatment depends on the cause, symptoms, and nature of the swallowing difficulty. After the assessment, your therapist will discuss the recommendations with you. Some 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 obtain an appointment to see the Speech Therapist?
You will require a referral letter from a Singapore-registered medical doctor, made out to SGH Speech Therapy Department. Please call SGH Central Appointment's Hotline at 63214377 to make an appointment.
Device Assisted Rehabilitation of Swallow (DARS) Clinic
The DARS clinic is a specialized clinic, where biofeedback tools are utilised to aid rehabilitation of dysphagia.
During your rehabilitation process, the speech therapist will explain about your swallowing presentation and discuss your goals for therapy and the extent of recovery expected for your condition. A series of personalised rehabilitation exercises will also be prescribed to you, depending on your swallowing presentation and severity of dysphagia.
The DARS clinic uses devices such as the Iowa Oral Performance Instrument (IOPI) and Surface electromyography (sEMG) to help with rehabilitatation of speech or swallowing 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. A block of intensive weekly visits may be suggested by your therapist, until you can do the exercises accurately on your own. The frequency of sessions vary, depending on your needs and progress.
If you would like to learn more about dysphagia, below are some resources that may be useful.
Your therapist may have given you some exercises for swallowing rehabilitation. Here are the handouts for some of those rehabilitation exercises. Please only commence on these exercises as suggested by your Speech Therapist. Please consult your therapist if you have any questions.