Dysphagia in Persons With Communication Disorders

Dysphagia in Persons With Communication Disorders

Gayathri Krishnan (All India Institute of Speech and Hearing, India) and S. P. Goswami (All India Institute of Speech and Hearing, India)
DOI: 10.4018/978-1-5225-4955-0.ch009

Abstract

Dysphagia (swallowing disorders) is any difficulty in swallowing that interferes with safe and adequate intake of nutrition and hydration requirements in an individual. It may present itself as a symptom of another underlying medical condition or as a consequence of surgical and pharmacological treatment. While in few, dysphagia resolves itself as a transient phase; in the rest, dysphagia demands immediate treatment. It may be seen as an associated dysfunction in persons with communication disorders (PsWCD) as speech and swallowing functions share many neuro-musculo-skeletal structures at the oral, pharyngeal, and laryngeal level along with their central control processes. This chapter aims at introducing the readers to the signs and symptoms of dysphagia in PsWCD. This is expected to guide the team of professionals working with PsWCDin identification and making appropriate referrals to the concerned professional for effective intervention. This further can accelerate the progress and prognosis of PsWCD towards improved health, development, and quality of life.
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Introduction

Dysphagia is defined as problems involving the oral cavity, pharynx, esophagus, or gastro esophageal junction because of which an individual fails in taking adequate hydration and/or nutrition essential for healthy survival. Any congenital or acquired condition that affects the central neural control of structures involved in swallow (For example: Stroke, Cerebral palsy, Amyotrophic Lateral Sclerosis etc.) or any impairment in the peripheral neuro-musculo-skeletal function of oro-pharyngo-laryngo-esophageal structures (For example, head and neck cancer, Gastro-esophageal reflux disorders, dental malformations etc) can result in difficulties during eating or drinking. An individual with dysphagia may or may not be aware of its presence and often seeks medical treatment when the condition worsens considerably leading to deteriorated health and poor quality of life. Persons with communication disorders (PsWCD) often fall into this category of the neglected population with dysphagia because of the wide range and degree of symptoms presented. Issues with feeding and swallowing may range from mild to severe depending on the underlying cause of dysphagia. For example, in a child with cleft lip and palate (CLP), the initial focus of treatment is to ensure safe and adequate nutrition rather than cosmetic considerations. But the prime focus in the treatment of an individual diagnosed with oral carcinoma will be to improve life expectancy rather than feeding issues. In these individuals, dysphagia is neglected initially till it becomes a cause of distress in the individual and their family members, though prophylactic management is recently gaining appreciation across the world. It is often forgotten that basic nutrition and hydration will only accelerate recovery, development, and progress in all domains of life in a PsWCD (Ekberg, Hamdy, Woisard, Wuttge-Hannig, and Ortega, 2002; Farri, Accornero, and Burdese, 2007). This can immensely improve the overall quality of life (QoL) of the individual and add value to the treatment, management or rehabilitation services provided. A Speech-Language Pathologist (SLP) is trained to identify, assess and establish rehabilitation goals for these individuals’ through varied approaches such as behavioral and motor skill training. Through graded sensory-motor stimulation and exercise based regimes combined with carefully selected dietary and environmental modifications, a qualified SLP can bring a marked difference in mealtime performance of PsWCD. A complete description of various strategies is beyond the scope of this chapter and readers are directed to reading elsewhere (Logemann and Logemann, 1983).

The aim of this chapter is to introduce the readers to various signs and symptoms of dysphagia that are commonly observed in PsWCD across the lifespan. By being observant and vigilant towards the possibility of the existence of this associated condition in their client group, the practicing rehabilitation professionals can identify and make appropriate referrals for the early and effective intervention of the individual for improving one of the basic functions and thereby accelerating betterment of overall health and wellbeing.

Key Terms in this Chapter

Bradycardia: Slowing down of heart rate.

Failure to Thrive: Children who do not gain weight or are gaining weight inappropriately leading to survival difficulties.

Quality of Life: All parameters that can measure the general physical, personal, and social wellbeing of an individual.

Aspiration: Entry of swallowed food or liquid into the region below vocal folds.

Mastication: The process of chewing to break down food particles so that it can be swallowed safely.

Hypoplasia: Underdevelopment or incomplete development of a structure.

Non-Oral Feeding: The process of ingesting nutrition/hydration through methods other than the mouth. For example, tube feeding.

Video-Fluroscopy: A radiological imaging procedure.

Aspiration Pneumonia: An infection of lungs caused by continued breathing in and accumulation of food/liquid into the airway.

Communication Disorders: Any condition that hinders a person from expressing their needs and ideas due to difficulties in understanding and formulating language or execution of speech.

Sensory Processing: A function that receives information from peripheral senses and processes it to a motor or behavioral response.

Respiratory Apnea: A period of absence of breathing. In swallowing, apnea is the output of airway decoupling that is important in ensuring a safe swallow.

Penetration: Entry of swallowed food or liquid into the airway region above vocal folds.

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