Dysphagia Risk Assessment Quiz

Diagnoses Assessment: You may have a MINIMAL risk of dysphagia

What this means:

Dysphagia occurs when any of the Five Systems of Dysphagia do not function appropriately. Having a Dysphagia Diagnosis Risk simply means that there are some answers in your questionairre that indicate that although your risk might be minimal, there is indeed a reason to watch what you eat, when you eat, and be aware if you develop any symptoms of dysphagia. Having more diagnoses in your profile increases your risk. You might be feeling fine right now, but if you, for example, have a bad flu or get a case of bronchitis or pneumonia, that might be enough to trigger an episode of increased swallowing issues. Even if it is temporary, being aware of the risks can help you to modify your diet or take extra precautions during this episode to ally those risks of complications should they occur. If you should gain an additional diagnosis that is not temporary, an SLP might be your advocate in deciding what, if any, modifications could make you safer and reduce those risks long term.

Diagnoses Assessment: You may have a MODERATE risk of dysphagia

What this means:

Dysphagia occurs when any of the Five Systems of Dysphagia do not function appropriately. Having a Dysphagia Diagnosis Risk simply means that there are some answers in your questionairre that indicate that although your risk might be moderate, there is indeed a reason to watch what you eat, when you eat, and be aware if you develop any additional symptoms of dysphagia. Having more diagnoses in your profile increases your risk exponentially. You might be feeling moderately affected by your dysphagia at this point, but if you, for example, have a bad flu or get a case of bronchitis or pneumonia, that might be enough to trigger an episode of increased swallowing issues that could throw you into the high risk category. Being aware of the risks that you are experiencing can help you to modify your diet and/or take the extra precautions that your SLP is recommending to ally those risks of complications should they occur. As your diagnoses profile changes, your risk level can change as well.

Diagnoses Assessment: You may have a HIGH risk of dysphagia

What this means:

Dysphagia occurs when any of the Five Systems of Dysphagia do not function appropriately. Having a Dysphagia Diagnosis Risk simply means that there are some answers in your questionairre that indicate that your risk might be high and there are good reasons to watch what you eat, when you eat, and be aware if you develop any additional symptoms of dysphagia. Having more diagnoses in your profile increases your risk exponentially. You might be feeling highly affected by your dysphagia at this point, but if you, for example, have a bad flu or get a case of bronchitis or pneumonia, that might be enough to trigger an even more severe episode of increased swallowing issues that could throw you into the high risk category that might need additional medical intervention. Being aware of the risks that you are experiencing can help you to modify your diet and/or take the extra precautions that your SLP is recommending to ally those risks of complications should they occur. As your diagnoses profile changes, your risk level can change as well.

Special Consideration: CVA + COPD + GERD + Congestive Heart Failure

Having suffered from a CVA (Stroke) and having diagnoses of CHF ( Congestive Heart Failure), COPD and GERD (Reflux), your dysphagia risk is triggered as high. This is because although one diagnoses consistent with having dysphagia may be more easily managed, having multiple diagnoses together can increase that risk exponentially.

Patients with a CVA often have issues with feeling the food and liquid as it passes through the mouth and throat, thus delaying the brain's trigger that something needs to be swallowed. In addition, the muscles of the face and throat may be weakend by the Stroke. CHF, or Congestive Heart Failure, often causes increased fatigue and secretions in the mouth and throat. This in turn can interfere with the food and liquid transit through the swallowing process. Think of it this way. If your throat is already full of foamy secretions, where is the food and liquid going to go before you swallow? The risk of it falling into the airway increases with the secretions that accompany CHF. In addition, fatigue is a common symptom of CHF and this fatigue can hinder safe, strong swallows all through the meal or snack process. Finally, having GERD, known as reflux, the food and/or liquid should go in one direction down into the stomach and stay down. If it is coming back up, now mixed with acid, it can reappear in the throat and fall into the airway in what is known as silent reflux or respiratory reflux. This can interfere with the swallowing coordination.

Therefore this combination of diagnoses that you chose in the quiz can result in several issues that make chewing and swallowing, and keeping the food down more difficult. All of this can affect your ability to rehabiliatate from your medical issues with increase potential for coughing, choking, congestion, dehydration, aspiration penumonia, and even malnutrition.

It may be important to consult with your Speech Pathology Dysphagia Expert in order to assess your individual risk and see what, if anything, you might be able to do to enhance your rehabilitation potential.

Special Consideration: Alzheimer's + COPD + GERD + Cardiac Event

A patient that has been diagnosed with Alzheimer's Disease goes through several stages of the disease process. During that journey, the potential for dysphagia to develp is very high. There are several issues that seem to evolve including an aversion to certain textures or tastes, chewing difficulties, issues with initiating the swallow once the food is in the mouth, and even negative reactions to the process of being at a table or having the food in front of them. This alone can be difficult, but unfortunately this is normally not the only diagnosis that this patient is dealing with.

Adding a Cardiac event, with or without surgery, increases the risk of dysphagia symptom complications because of several possible issues such as muscle and nerve damage, which may be temporary from treatment or surgery, and can have affect on the respiratory and gastrointestinal system from both the anesthetic and multiple medications necessary to stabilize the patient toward recovery. Having a COPD diagnosis affects the ability to hold one's breath hundreds of time throughout a meal as is necessary to complete the swallow which in an already compromised system can be extemely fatiguing.

Finally, having GERD, known as reflux, the food and/or liquid should go in one direction down into the stomach and stay down. If it is coming back up, now mixed with acid, it can reappear in the throat and fall into the airway in what is known as silent reflux or respiratory reflux. This can interfere with the swallowing coordination. Therefore this combination of diagnoses that you chose in the quizz can result in several issues that make chewing and swallowing, keeping the food down, and staying as nutritionally sound and hydrated as possible even more difficult. All of this can affect your ability to rehabiliatate from your medical issues with an increased potential for coughing, choking, congestion, dehydration, aspiration penumonia, and even malnutrition.

It may be important to consult with your Speech Pathology Dysphagia Expert in order to assess your individual risk and see what, if anything, you might be able to do to enhance your rehabilitation potential.

Special Consideration: Neurological Disease + COPD + GERD

Swallowing is a complex neurological process that requires signals from the structures involved in swallowing to work in coordination with the brain. When you put the food or liquid into your mouth the brain immediately wants to know whether it is hot, cold, sweet, sour, needs to be chewed a lot or a little, if it is a big bite size, how hard the muscles need to work in order to move it from the mouth to the throat, and even how big the esophagus needs to open in order to accept the bite or sip. This neurological system is amazing. When a neurological disease is present,some of the vital pieces of information get lost and the brain doesn't know exactly what to tell the swallowing mechanism to do.

Adding an additional diagnosis of GERD, known as reflux, to this already complicated process increases the risk. When we eat or drink, the food and/or liquid should go in one direction down into the stomach and stay down. If it is coming back up, now mixed with acid, it can reappear in the throat and fall into the airway in what is known as silent reflux or respiratory reflux. This can interfere with the swallowing coordination necessary for a safe swallow. Having a COPD diagnosis alone affects the ability to hold one's breath hundreds of time throughout a meal as is necessary to complete the swallow which in an already compromised system can be extemely fatiguing.

Therefore this combination of diagnoses that you chose in the quizz can result in several issues that make chewing and swallowing, keeping the food down, and staying as nutritionally sound and hydrated as possible even more difficult. All of this can affect your ability to rehabiliatate from your medical issues with an increased potential for coughing, choking, congestion, dehydration, aspiration penumonia, and even malnutrition.

It may be important to consult with your Speech Pathology Dysphagia Expert in order to assess your individual risk and see what, if anything, you might be able to do to enhance your rehabilitation potential.

Special Consideration: Neurological Disease + GERD + Congestive Heart Failure

Swallowing is a complex neurological process that requires signals from the structures involved in swallowing to work in coordination with the brain. When you put the food or liquid into your mouth the brain immediately wants to know whether it is hot, cold, sweet, sour, needs to be chewed a lot or a little, if it is a big bite size, how hard the muscles need to work in order to move it from the mouth to the throat, and even how big the esophagus needs to open in order to accept the bite or sip. This neurological system is amazing. When a neurological disease is present, some of the vital pieces of information get lost and the brain doesn't know exactly what to tell the swallowing mechanism to do.

Adding an additional diagnosis of GERD, known as reflux, to this already complicated process increases the risk. When we eat or drink, the food and/or liquid should go in one direction down into the stomach and stay down. If it is coming back up, now mixed with acid, it can reappear in the throat and fall into the airway in what is known as silent reflux or respiratory reflux. This can interfere with the swallowing coordination necessary for a safe swallow.

CHF, or Congestive Heart Failure, often causes increased fatigue and secretions in the mouth and throat which can interfere with the food and liquid transit through the swallowing process. Think of it this way. If your throat is already full of foamy secretions, where is the food and liquid going to go before you swallow? The risk of it falling into the airway increases with the secretions that accompany CHF. In addition, fatigue is a common symptom of CHF and this fatigue can hinder safe, strong swallows all through the meal or snack process.

Therefore this combination of diagnoses that you chose in the quiz can result in several issues that make chewing and swallowing, keeping the food down, and staying as nutritionally sound and hydrated as possible even more difficult. All of this can affect your ability to rehabiliatate from your medical issues with an increased potential for coughing, choking, congestion, dehydration, aspiration penumonia, and even malnutrition.

It may be important to consult with your Speech Pathology Dysphagia Expert in order to assess your individual risk and see what, if anything, you might be able to do to enhance your rehabilitation potential.

Special Consideration: Alzheimer's + Cardiac Event + GERD + Congestive Heart Failure

A patient that has been diagnosed with Alzheimer's Disease goes through several stages of the disease process. During that journey, the potential for dysphagia to develp is very high. There are several issues that seem to evolve including an aversion to certain textures or tastes, chewing difficulties, issues with initiating the swallow once the food is in the mouth, and even negative reactions to the process of being at a table or having the food in front of them. This alone can be difficult, but unfortunately this is normally not the only diagnosis that this patient is dealing with.

Adding a Cardiac event, with or without surgery, increases the risk of dysphagia symptom complications because of several possible issues such as muscle and nerve damage. This may be temporary from treatment or surgery and can affect the respiratory and gastrointestinal system from both the anesthetic and multiple medications necessary to stabilize the patient toward recovery.

CHF, or Congestive Heart Failure, often causes increased fatigue and secretions in the mouth and throat which can interfere with the food and liquid transit through the swallowing process. Think of it this way. If your throat is already full of foamy secretions, where is the food and liquid going to go before you swallow? The risk of it falling into the airway increases with the secretions that accompany CHF. In addition, fatigue is a common symptom of CHF and this fatigue can hinder safe, strong swallows all through the meal or snack process.

Finally, having GERD, known as reflux, is a risk as the food and/or liquid should go in one direction down into the stomach and stay down. If it is coming back up, now mixed with acid, it can reappear in the throat and fall into the airway in what is known as silent reflux or respiratory reflux. This can interfere with the swallowing coordination.

Therefore, this combination of diagnoses that you chose in the quiz can result in several issues that make chewing and swallowing, keeping the food down, and staying as nutritionally sound and hydrated as possible, even more difficult. All of this can affect your ability to rehabiliatate from your medical issues with an increased potential for coughing, choking, congestion, dehydration, aspiation penumonia, and even malnutrition.

It may be important to consult with your Speech Pathology Dysphagia Expert in order to assess your individual risk and see what, if anything, you might be able to do to enhance your rehabilitation potential.

Symptoms Assessment: You may have a MINIMAL risk of dysphagia

What this means:

Dysphagia is caused by something else. It is not a disease in of itself in the absence of other issues. The symptoms of dysphagia are the indicator that something is not functioning as it should. The symptoms that you indicated you were experiencing, although minimal in risk, are an indication that something is not quite right. For example, if you are experiencing GERD (heartburn or reflux) and a feeling like something is stuck in your throat, that is not in of itself a high risk of dysphagia complications. However, if it progresses to coughing or choking during medication presentation or meals, and the GERD worsens, and you begin to feel congestion, that means your symptoms are worsening. Watching your symptoms, trying to keep them as minimal as possible with lifestyle or dysphagia technique management changes, and being in communication with your physician or speech pathologist will all help to keep you safe and healthier long term.

Symptoms Assessment: You may have a MODERATE risk of dysphagia

What this means:

Dysphagia is caused by something else. It is not a disease in of itself in the absence of other issues. The symptoms of dysphagia are the indicator that something is not functioning as it should. The symptoms that you indicated you were experiencing are an indication of a moderate risk and evidence that something is not quite right. For example, if you are experiencing GERD (heartburn or reflux) and a feeling like something is stuck in your throat, that is not in of itself a high risk of dysphagia complications. However, if it progresses to coughing or choking during medication presentation or meals, and the GERD worsens, and you begin to feel congestion, that means your symptoms are worsening and your risk is elevating. Watching your symptoms, trying to keep them as minimal as possible with lifestyle or dysphagia technique management changes, and being in communication with your physician or speech pathologist will all help to keep you safe and healthier long term.

Symptoms Assessment: You may have a HIGH risk of dysphagia

What this means:

Dysphagia is caused by something else. It is not a disease in of itself in the absence of other issues. The symptoms of dysphagia are the indicator that something is not functioning as it should. The symptoms that you indicated you were experiencing are an indication of a high risk and evidence that something is not functioning quite right. For example, if you are experiencing GERD (heartburn or reflux) and a feeling like something is stuck in your throat, that is not in of itself a high risk of dysphagia complications. However, if it progresses to coughing or choking during medication presentation or meals, the GERD worsens, and you begin to feel congestion consistently, that means your symptoms are worsening and your risk is elevating. Watching your symptoms, trying to keep them as minimal as possible with lifestyle or dysphagia technique management changes, and being in communication with your physician or speech pathologist will all help to keep you safe and healthier long term.

Special Consideration: Breathless While Eating/Drinking + Coughing During Meals + GERD

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being breathless while you are eating or drinking, or even a few hours after eating or drinking is cause for concern. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway. Bottom line, feeling breathless during or following meals is a moderate risk for complications on its own.

If you add coughing during meals to that scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or for other reasons. Only a thorough swallowing diagnostic can determine the root cause of that cough during the meals. Regardless of the reason however, coughing interrupts the finely coordinated movements that all of the parts of the swallowing mechanism must make in order to transit the food and liquid safely through the mouth and pharynx and into the esophagus, and must be investigated to bring relief to the the patient and an increase in safety to the swallow.

GERD, or reflux, is more complicated as it is caused by a malfunction in the gastrointestinal systems and is a normally a combination of the function of the anatomy of your GI system along with diet and lifestyle choices. When the reflux re-enters the pharynx, or throat, it then is either swallowed again or it can fall into the airway in aspiration. This can even be happening when you sleep. Since 50% of all reflux is silent, meaning that you don't know its happening because you aren't feeling heartburn symptoms, you might not even be aware of this increased risk from effects of reflux.

Having chosen these three symptoms in your quiz, the combination increases your risk of complications of dysphagia such as coughing, choking, aspiration, congestion, pneumonia, dehydration and even malnutrition. It can affect how you feel in a negative way and can delay or detour your rehabilitation or management of your medical diagnoses. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Congestion + GERD + Fatigue

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being congested, whether temporarily or on a chronic basis, is cause for concern. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway.

Bottom line, being congested is a risk for complications on its own. If you add the coughing during meals that often accompanies congestion to that scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or because you are stirring up the congestive secretions and phlegm during the swallowing process. Only a thorough swallowing diagnostic can determine the effect that the congestion is having during the meals.

GERD, or reflux, is more complicated as it is caused by a malfunction in the gastrointestinal systems and is a normally a combination of the function of the anatomy of your GI system along with diet and lifestyle choices. When the reflux re-enters the pharynx, or throat, it then is either swallowed again or it can fall into the airway in aspiration. This can even be happening when you sleep. Since 50% of all reflux is silent, meaning that you don't know its happening because you aren't feeling heartburn symptoms, you might not even be aware of this increased risk from effects of reflux.

Fatigue is something that is often overlooked as a risk for dysphagia. The amount of energy that it takes to chew, move the food and liquid through the mouth and throat, hold one's breath for 1-2 seconds to complete the swallow, and repeat this over and over hundreds of times, is understated. It takes a lot of energy to eat, and depending on the texture of the food, that energy can be increased or decreased. Often patients start out with strong swallows and because of the fatigue they are experiencing from their diagnostic profile, their swallow weakens after a short time and the risk of aspiration increases.

Having chosen these three symptoms in your quiz, the combination increases your risk of complications of dysphagia such as coughing, choking, aspiration, congestion, pneumonia, dehydration and even malnutrition. It can affect how you feel in a negative way and can delay or detour your rehabilitation or management of your medical diagnoses. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Congestion + GERD + Feeling Something in Throat

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being congested, whether temporarily or on a chronic basis, is cause for concern. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway.

Bottom line, being congested is a risk for complications on its own. If you add the coughing during meals that often accompanies congestion to that scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or because you are stirring up the congestive secretions and phlegm during the swallowing process. Only a thorough swallowing diagnostic can determine the effect that the congestion is having during the meals.

GERD, or reflux is more complicated as it is caused by a malfunction in the gastrointestinal systems and is a normally a combination of the function of the anatomy of your GI system along with diet and lifestyle choices. When the reflux re-enters the pharynx, or throat, it then is either swallowed again or it can fall into the airway in aspiration. This can even be happening when you sleep. Since 50% of all reflux is silent, meaning that you don't know its happening because you aren't feeling heartburn symptoms, you might not even be aware of this increased risk from effects of reflux.

Feeling as if you have something stuck in your throat can be indicative of a number of situations. You may actually be having residue of the food that you are eating sticking to the base of your tongue, therefore causing discomfort, or you may be having other issues related to your GERD and irritation of the tissues. Without a thorough diagnostic with a swallowing instrumentation to directly view the structures involved in swallowing and their function, these are but two of many scenarios. Having this feeling, however, indicates that something is not functioning as it should and that further investigation may be warranted.

Having chosen these three symptoms in your quiz, the combination increases your risk of complications of dysphagia such as coughing, choking, aspiration, congestion, pneumonia, dehydration and even malnutrition. It can affect how you feel in a negative way and can delay or detour your rehabilitation or management of your medical diagnoses. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Congestion + Breathless While Eating/Drinking

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being congested, whether temporarily or on a chronic basis, is cause for concern. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway.

Bottom line, being congested is a risk for complications on its own. If you add the coughing during meals that often accompanies congestion to that scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or because you are stirring up the congestive secretions and phlegm during the swallowing process. Only a thorough swallowing diagnostic can determine the effect that the congestion is having during the meals.

Being breathless while you are eating or drinking, or even a few hours after eating or drinking is also a cause for concern, especially in combination with congestion as a symptom. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway. Bottom line, feeling breathless during or following meals is a moderate risk for complications on its own.

Having chosen these symptoms in your quiz, the combination increases your risk of complications of dysphagia such as coughing, choking, aspiration, congestion, pneumonia, dehydration and even malnutrition. It can affect how you feel in a negative way and can delay or detour your rehabilitation or management of your medical diagnoses. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Congestion + GERD + Coughing During Meals

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being congested, whether temporarily or on a chronic basis, is cause for concern. This may be caused by the food or liquid, or both, falling into the airway before, during, or after the swallow. This can be happening because of reflux or it can happen because you cannot control the texture of the food or liquid and may not feel it as its falling into the airway.

Bottom line, being congested is a risk for complications on its own. If you add the coughing during meals that often accompanies congestion to that scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or because you are stirring up the congestive secretions and phlegm during the swallowing process. Only a thorough swallowing diagnostic can determine the effect that the congestion is having during the meals.

GERD, or reflux, is more complicated as it is caused by a malfunction in the gastrointestinal systems and is normally a combination of the function of the anatomy of your GI system along with diet and lifestyle choices. When the reflux re-enters the pharynx, or throat, it then is either swallowed again or it can fall into the airway in aspiration. This can even be happening when you sleep. Since 50% of all reflux is silent, meaning that you don't know its happening because you aren't feeling heartburn symptoms, you might not even be aware of this increased risk from effects of reflux.

If you add coughing during meals to this scenario, you must determine whether the cough is being caused by the food or liquid falling into the airway or for other reasons. Only a thorough swallowing diagnostic can determine the root cause of that cough during the meals. Regardless of the reason however, coughing interrupts the finely coordinated movements that all of the parts of the swallowing mechanism must make in order to transit the food and liquid safely through the mouth and pharynx and into the esophagus, and must be investigated to bring relief to the the patient and an increase in safety to the swallow.

Having chosen these three symptoms in your quiz, the combination increases your risk of complications of dysphagia such as coughing, choking, aspiration, congestion, pneumonia, dehydration and even malnutrition. It can affect how you feel in a negative way and can delay or detour your rehabilitation or management of your medical diagnoses. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Congestion + G-Tube

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Being congested, whether temporarily or on a chronic basis, is cause for concern. This can be happening because of reflux, and you may not feel the aspirate as its falling into the airway. Bottom line, being congested is a risk for complications on its own.

When the patient is also on a G-Tube feeding and they are congested, there is an immediate red-flag for complications. When a G-tube is placed into the stomach, the stomach is theoretically emptied of its acid. In addition, the patient is normally put on an acid suppressant and antibiotic after G-tube placement. Now fast forward to a few weeks later. The antibiotics are almost over, the stomach is having a gastric acid rebound after being emptied, and the PPI medication to suppress the acid is working. It is important to note that acid suppressants or PPI's do not stop reflux from occurring, rather it suppresses the effects of the acid or burning that you feel.

It is not unusual for the patient with a G-tube to have reflux of the tube feeding that comes back up into the pharynx and falls into the airway in aspiration. This can happen when the patient is sleeping or laying down, and the effects can be deleterious to the patient's condition, resulting in congestion and even pneumonia. Effectively managing the G-tube feeding schedule, positioning and other factors can reduce this risk, if in fact this is happening.

Having these two symptoms together pushes the patient risk of dysphagia complications into the high category. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Special Consideration: Breathless while Eating/Drinking + G-Tube

Dysphagia is caused by something, a diagnosis or multiple diagnoses in fact. The symptoms that the dysphagia causes are indicative of the level of risk that you have for adverse health events related to the dysphagia. Feeling breathless, whether temporarily or on a chronic basis, is cause for concern. This may be caused by aspirate falling into the airway because of reflux and you may not feel it as its falling into the airway. Bottom line, feeling breathless is a risk for complications on its own.

When the patient is also on a G-Tube feeding and they are feeling breathless, it may mean that they have the beginnings of a congestive episode and there is an immediate red-flag for complications. When a G-tube is placed into the stomach, the stomach is theoretically emptied of its acid. In addition, the patient is normally put on an acid suppressant and antibiotic after G-tube placement. Now fast forward to a few weeks later. The antibiotics are almost over, the stomach is having a gastric acid rebound after being emptied, and the PPI medication to suppress the acid is working. It is important to note that acid suppressants or PPI's do not stop reflux from occurring, rather it suppresses the effects of the acid or burning that you feel.

It is not unusual for the patient with a G-tube to have reflux of the tube feeding that comes back up into the pharynx and falls into the airway in aspiration. This can happen when the patient is sleeping or laying down, and the effects can be deleterious to the patient's condition, resulting in congestion and even pneumonia. Effectively managing the G-tube feeding schedule, positioning and other factors can reduce this risk, if in fact this is happening.

Having these two symptoms together pushes the patient risk of dysphagia complications into the high category. The more symptoms one is experiencing, the more deleterious the effects of dysphagia might be.

A conversation with your SLP Dysphagia Expert to discuss your symptoms may be in order to re-direct you towards figuring out what you can do to reduce or eliminate these symptoms and potentially have a more positive rehabilitation experience.

Home Care Situation Assessment: You may have a MINIMAL risk of dysphagia

What this means:

The Home Care situation is vital to understanding dysphagia risk. Based on your choices, although your home care situation dysphagia risk is low, it is important to be aware how any changes to this situation can affect your dysphagia risk. For example, if you presently have a spouse or caregiver, given the medical condition that you are in at the present time, but that spouse or caregiver no longer becomes a daily part of your life, your risk changes. The attention, help, emotional and physical support that you have affects your potential risk for the deleterious effects of dysphagia. If changes should occur, perhaps retake the quiz and see where you land, then discussing it with your doctor, loved ones, or caregivers who surround you.

Home Care Situation Assessment: You may have a MODERATE risk of dysphagia

What this means:

The Home Care situation is vital to understanding dysphagia risk. Based on your choices, although your home care situation dysphagia risk is moderate at this time, it is important to be aware how any changes to this situation can affect your dysphagia risk. For example, if you presently have a spouse or caregiver, given the medical condition that you are in at the present time, but that spouse or caregiver no longer becomes a daily part of your life, your risk changes. Something that singular can change the landscape of your safety in managing your dysphagia. The attention, help, emotional and physical support that you have in your daily life affects your potential risk for the deleterious effects of dysphagia. If changes should occur, perhaps retake the quizz and see where you land, then discussing it with your doctor, loved ones, or caregivers who surround you.

Home Care Situation Assessment: You may have a HIGH risk of dysphagia

What this means:

The Home Care situation is vital to understanding dysphagia risk. Based on your choices, although your home care situation dysphagia risk is high at this time, it is important to be aware how any changes to this situation can affect your dysphagia risk. For example, if you presently have a spouse or caregiver, given the medical condition that you are in at the present time, but that spouse or caregiver no longer becomes a daily part of your life, your risk changes. Something that singular can change the landscape of your safety in managing your dysphagia. The attention, help, emotional and physical support that you have in your daily life affects your potential risk for the deleterious effects of dysphagia. If changes should occur, perhaps retake the quiz and see where you land, then discussing it with your doctor, loved ones, or caregivers who surround you.

Alcohol or Drug Abuse & Dysphagia

Excessive alcohol consumption over a long period of time can cause dysphagia as the alcohol damages the esophagus. Heavy drinkers often vomit frequently, causing skin tears and acid irritation in the esophagus, as also seen with people with eating disorders such as bulimia nervosa. Drug Abuse can cause similar effects, depending on the drugs ingested. It is improtant to also note that both alcohol and drug abuse can be linked to an increased incidence of GERD.

Alzheimer's & Dysphagia

The high prevalence of dysphagia among individuals with dementia is the result of age-related changes to sensory and motor functions, in addition to those produced by neuropathology, according to the National Institutes of Health . The prevalence of dysphagia in moderate to severe Alzheimer's Disease is from 84 to 93%.

Aspiration Pneumonia

Research states that aspiration pneumonia most frequently occurs in people with dysphagia, a swallowing disorder. Several conditions are associated with dysphagia and increase a person's risk of developing aspiration pneumonia. They include: esophageal disorders or dysfunction, use of muscle relaxers, sedatives or anesthesia, dental problems, problems with the nerves (neurological disorders), throat cancer, stroke, seizure, heart attack, coma or other states of impaired consciousness, gastrointestinal reflux disease (GERD) or heartburn, and disorders that impair the mental state, such as dementia.

Cancer of Head or Neck

Research by Manikatan, etal (2009) state that dysphagia is an important symptom of head and neck cancer (HNC), as well as representing a significant complication of its treatment. The treatment of HNC can result in neuromuscular and sensory damage affecting any stage of the swallow. The protective mechanisms during swallowing afforded by the structures in the pharynx are also affected in HNC

Cancer Treatment - Other

Swallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. ( Verdonck-de Leeuw et al, 2012). Understanding your risk as associated with your particular treatment protocol is vital in planning for your dysphagia management as you recover.

Cardiac Event or Surgery

A cardiac event, such as a heart attack or surgical procedures to the heart, can cause a dysphagia that can be temporary. The cause can be a number of things including pressure in the chest because of the underlying disease diagnosis, the effects of anesthesia and the breathing tube having been present during the surgery. Damage (although perhaps temporary) to the muscles and nerves within the chest, the effects of medications following surgery, and the overall fatigue or depression that can occur after such procedures also increases risk. Being aware that dysphagia can occur, and taking the precautions to stay safe following the surgery or procedures, can aid in a healthier recovery. Paired with other co-morbidities, the risk can elevate.

Congestive Heart Failure

Dysphagia incidence is approximately 40% in patients with CHF. Studies reveal that comorbidity of dysphagia was high in patients with acute exacerbation of CHF. It is suggested that the benefit of early detection of patients with dysphagia may contribute to prevention of aspiration pneumonia, shortening length hospitalization, and improvement of prognosis in patients with acute exacerbation of CHF. (Yokota et al, 2016)

COPD

Dysphagia is a comorbidity with COPD in approximately 20.5% of patients at any given time. This is because COPD disrupts the typical coordination between the swallowing and respiratory systems, leading to impairments and inefficiencies in the swallowing process.

Cognitive Impairment - Mild

Swallowing comes from the central command area of the brain in that it is alerted that something is in the mouth that needs to be chewed, transited through the mouth and pharynx, and then needs to be swallowed. When there is a mild cognitive impairment, it can disrupt these signals. In addition, techniques and compliance to a safe diet can become more difficult to manage.

Concussion (Single or Repeat)

A recent head injury may impair the signals between the brain and the swallowing mechanism, disrupting the ability of the process to occur safely.

Covid

Covid 19 and Long Covid may impair the swallow in multiple ways from the neurological feeling of the food and liquid in the mouth, the ability to respiratorily hold one's breath to swallow, the ability to muscularly transit the food through the swallowing mechanisms, and gastrointestinally to keep the food and liquid down in the stomach after swallowing. Finally, cognitive processing may be dampened or delayed with Covid-19, making safe choices and techniques more difficult.

Diabetes

Managing Diabetes can be difficult, but it is made more complicated by having dysphagia. Nutrition, hydration, and blood sugar levels that are within range are vital for diabetes control. When diabetes is not controlled appropraitely and blood sugar levels are low, it can affect all three phases of the swallow (oral, pharyngeal, and esophageal), especially the oropharyngeal phase, or getting the food and liquid through the mouth and pharynx to be swallowed without falling into the airway.

CVA

The incidence of dysphagia following a stroke is approximately 50.4%. This can be caused by a myriad of reasons following stroke including but not limited to neurological damage to those areas involved in swallowing, muscular weakness, increased gastrointestinal issues, diminished respiratory system response, and a decreased cognitive system because of either the stroke or the medications necessary for recovery.

GERD – Gastro Esophageal Reflux

Reflux Dysphagia occurs when the food or liquid is swallowed, goes down into the esophagus and into the stomach, and then comes back up all the way into the throat (pharynx) again. When this happens, the food/liquid can fall into the airway as aspiration. Since 50% of reflux is noted to be silent (meaning one does not know it is occurring), this can be very caustic to the respiratory system and can result in congestion and even aspiration pneumonia. It is very important to manage one's reflux with a variety of techniques and modifications for long-term health.

G-Tube Placement For Feeding

A G-tube has been placed in order to provide the nutrition and hydration needed to sustain life. When a G-tube is necessary, this is an indication that the dysphagia is a high risk because of aspiration, choking, dehydration, malnutrition and a variety of other reasons. It is important to assess the ongoing need for the G-tube in order to see if additional oral feeding for pleasure or weaning from the G-tube is possible.

Head and/or Neck Surgery

Surgery to the head or neck disrupts the muscles and nerves necessary for a functional swallowing process. Whether the damage is intermittant ( meaning it will heal as one heals from the surgery) or permanent (meaning other techniques and compensatory strategies need to be evaluated), it is vital to understand that you will have a risk following the surgery. Planning effectively both before and after the surgery is vital to maintain health and to have the best outcome possible.

Hemiplegia or Paralysis of Limb(s)

The respiratory tract is vital to swallowing in that one must hold their breath for 1-2 seconds in order to close the vocal cords and protect the airway during swallowing. If a Hemiplegia or paralysis of a limb or limbs is present, it is vital to assess the function of the swallowing mechanism to see if all parts are working as they should. In addition, walking, talking, and breathing deeply help protect the airway by ridding itself of sectretions and generating a healthy oxygen to blood exchange. When one has mobility problems, this diminishes the ability to breathe deeply and help oxegenate the body. These are all considerations to assess dysphagia risk.

Hip Fracture

Hip fractures require surgery. Surgery requires anesthesia. The incidence of dysphagia following anesthesia comes from the act of being intubated (having the breathing tube inserted between your vocal folds and into your trachea). This intubation can cause an issue with the coordination of the swallowing mechanism that can last a few days, weeks, months, or can be longer term. It is important to take this into consideration following a hip repair as the patient is not mobile (less air moving through the lungs to help clean them out) and may be fatigued or depressed with less talking and interacting. All of these considerations may lead to a congestive episode or even an aspiration pneumonia risk.

Neurological Disease and/or MS, ALS, Huntington’s, Parkinson’s

The incidence of Dysphagia (with or without aspiration pneumonia) is reported to be 81.1% with Parkinson’s disease, 45% with MS, 30% at diagnosis and 80% as disease progresses with ALS, and 75% with Huntington's Disease. Depending on where in the disease process the patient presently resides, the dysphagia can be anywhere from a moderate to a high risk. Learning to manage the dysphagia upon diagnosis is vital to longer term management of the dysphagia effects.

TIA – Trans Ischemic Attack

A TIA or Trans Ischemic Attack is a mini-stroke. Dysphagia can occur during and following the attack. Assessing the other results of the TIA, symptoms that are ongoing, and residual effect of the TIA on swallowing are vital. These may include a discoordinated swallow, loss of sensation, increased reflux, and feeling out of breath while eating.

Tracheostomy – Presently or within last year

A tracheostomy is placed in order to open the airway and provide a path for oxygenation to the body. When a trach is placed, it can negatively affect the upward and forward movement of the larynx, which protects the airway during swallowing. Dysphagia occurs when this interruption is present, which then increases the risk of aspiration into the airway it is meant to protect. Dysphagia management is vital to ally this risk.

Vocal Cord Nodules

Our vocal cords are like two ribbons that vibrate when we speak and that close tightly to protect the airway during swallowing. A nodule is a bump on the vocal cord, and as such it impeded the smooth and tight closure of the cords. This risk can be significant if the other two protective mechanisms of the airway ( false vocal cords closing and epiglottis retroverting) are ineffective. Understanding the function of your particular vocal cords with its nodules, makes it easier to manage.

Bad Taste in Mouth

A bad taste in the mouth can indicate the presence of Reflux (GERD). Since 50% of reflux is silent (meaning you don't know that it is happening, or that your PPI medication is taking away the heartburn feeling) this bad taste may be an indication that some lifestyle or diet changes might help!

Breathless During or Following Meals

One has to hold their breath hundreds of times while eating a meal when the vocal cords close to protect the airway from the food and liquids as they pass by. Becoming breathless while eating or following meals indicates that there is a reason that this is happening. Identifying the exact nature of the function of your swallowing mechanism is vital to determining whether there is something that can lessen the breathlessness and strengthen the swallow.

Choking Episodes

When food and/or liquid falls into the airway and the nerves are working properly, the result will be a cough. This is your body's way of trying to clear the airway of the offending material. Choking while eating or drinking happens for a reason, normally a discoordination of the swallowing process. Modifying the techniques, strategies, foods or liquids, or compensatory movements can help. This needs to be evaluted as it is a high risk.

Chronic Fatigue

Swallowing is a process that requires repeated coordinated movements throughout the mouth, throat, and into the esophagus. With chronic fatigue, the mechanism may feel slowed or diminished in its ability to transit the food and liquid effectively through the system. In addition, medications being taken for chronic fatigue may enhance the swallowing issues. Being aware of the risks can help one to be safer when feeling fatigued.

Complaint of feeling full after minimal ingestion

Feeling full after minimal ingestion can mean several different things. One that is particularly related to dysphagia is the effectiveness of the swallowing mechanism to take the food and liquid in a uni-directional path from the mouth to the stomach. Having the food or liquid stay in the esophagus, having reflux of the food or liquid, and silently aspirating food or liquid may give one this feeling of fullness. Accurate diagnosis and looking at the other symptoms and diagnosis will help to identify if this is related to dysphagia.

Congestion

Congestion can be cause by many different diagnoses, aspiration because of dysphagia being just one. It is important to consider dysphagia as a cause, including aspiration of the food and liquid on the way down to the stomach if the vocal cords do not close to protect the airway, or in reflux when it comes back up and falls into the airway. Research states that it takes a lot of acid to damage the esophagus when it comes back up from the stomach, but very little acid to damage the airway when it falls in between the vocal folds. As 50% of reflux is reported to be silent, the congestion should be investigated as a possible response to dysphagia if other characteristics apply.

Coughing during meals, medications or snacks

Coughing during meals, medications or snacks may be caused by a few different reasons, dysphagia being one of them. If the coughing is caused by a reaction to food or liquid falling between the vocal cords into the airway, dysphagia is the culprit. A cough interrupts the coordination of movements needed to swallow safely. The coughing can also be caused by the stress upon the system that has a respiratory compromise by a COPD, CHF, or even allergies or a cold. A dysphagia diagnosis and subsequent identification of what is causing the issue can be important to reducing the coughing during meals, thus increasing safety!

Fatigue or breathless while eating meals or snacks

One has to hold their breath hundreds of times while eating a meal when the vocal cords close to protect the airway from the food and liquids as they pass by. Becoming breathless while eating or following meals indicates that there is a reason that this is happening. Identifying the exact nature of the function of your swallowing mechanism is vital to determining whether there is something that can lessen the breathlessness and strengthen the swallow. This breathlessness can also become fatiguing. Swallowing is a process that requires repeated coordinated movements throughout the mouth, throat, and into the esophagus. WIth becoming fatigued, the mechanism may feel slowed or diminished in its ability to transit the food and liquid effectively through the system, thus reducing safety further.

Feeling of something stuck in the throat

A feeling of something being stuck in the throat may happen for a few different reasons. One of those reasons is dysphagia. When the swallow becomes discoordinated and inefficient, food and liquid residue may reside in the pharynx, whether on the base of the tongue, in the vallecular spaces, or in the pyriform sinus. Sometimes the food and liquid residue lies in the upper esophagus with inefficient swallowing, and reappears in the form of backflow into the pharynx. It is important to try and ascertain what the issues are so that they can be addressed. If it is not related to oropharyngeal dysphagia, a referral to a GI for a diagnostic procedure for the esophagus may be warranted.

G-Tube in place and tongue coated white with or without foamy secretions

A G-tube is placed through the wall of the abdomen and into the stomach. This is placed in order for nutrition or medications to be directed into the stomach. The feeding through the G-tube is done by either pouring the feeding liquid or medication into the tube at set times per day, or is provided by a continuous feeding machine. The object of the G-tube is to direct the feeding into the stomach and down into the intestines. Sometimes, however, the G-tube feeding fills up the stomach and then is refluxed back up into the esophagus and into the pharynx, much like food or liquid comes back after swallowing. If the base of the tongue is coated white, the tube feeing has made its way all the way up to the base of the tongue, likely while laying down. If there is no coating on the tongue but there are white foamy secretions that look to be similar in color to the feeding liquid, then the refluxed tube feeding is making its way up into the mouth. Asking the patient ' what does that feeding taste like?' often results in an answer of " chalk", which tells you that it is indeed coming up. That increases the likelihood that it is also being aspirated into the airway.

GERD / Reflux

Reflux Dysphagia occurs when the food or liquid is swallowed, goes down into the esophagus and into the stomach, and then comes back up all the way into the throat (pharynx) again. When this happens, the food/liquid can fall into the airway as aspiration. Since 50% of reflux is noted to be silent (meaning one does not know it is occurring), this can be very caustic to the respiratory system and can result in congestion and even aspiration pneumonia. It is very important to manage one's reflux with a variety of techniques and modifications for long-term health.

Increased secretions in mouth or throat

We all have secretions in our mouth to keep things lubricated and help to break down the food and liquids that we chew prior to swallowing. The amount of secretions can change according to the primary and secondary diagnoses. One can suspect that they have an excessive amount of secretions when they fall out of the front of mouth, feel as if they are choking us when they fall back into the throat, or when they require excessive swallowing or throat clears. Patients that have dysphagia may have increased secretions adding to their issues. There are a multitude of possibilities for handling increased secretions when they become a problem.

Intolerance to the texture of food or liquid

We all have our favorite foods, drinks, and even textures of foods or liquids. If you are experiencing an intolerance to a particular texture of food or liquid it is important to discuss with your Speech Pathologist. This can be caused by many different issues, besides preference. Different diagnoses, medications, situations, or treatments may cause this intolerance. Addressing it and finding other alternatives in foods and liquids, or changing the texture in a more palatable way is the key. This can be one piece of the dysphagia puzzle.

Oxygen Use

The patient that is using oxygen, regardless of the reason, increases the risk of dysphagia complications simply because they are more fragile. Although it is important for everyone to try and avoid aspiration, the healthy patient can cough out the aspirate and clear the airway. The patient that is on oxygen has a more difficult time clearing the airway with the flow of oxygen, in addition to the fact that they are using oxygen because of a lower pulse ox level indicating that the oxygen to blood exchange is diminished. This can result in fatigue and discoordination of the swallow. Identification and techniques to increase safety are paramount to keeping this patient healthy.

Weak voice, hoarseness, breathiness, gurgly quality

When food and/or liquid falls to the level of the vocal cords, the result can be a weakend movement of the vocal cords because of the food or liquid residue sitting upon them. This can be identified by a weakend voice or a gurgly quality to the voice. With the voice that sounds hoarse, one can suspect an insult to the vocal cords either post surgery (with intubation) or with acid reflux. Breathiness often happens either because of reflux and acid falling over the vocal cords, reducing their elasticity for a clear voice, or because of an infection or virus that is affecting the vocal cords. No matter the cause, it is but one piece of the puzzle to solve the mystery of how the dysphagia is affecting the body.

Weight Loss of more than 10lbs

One aspect of dysphagia is the resulting diminished eating and drinking because of the difficulty with swallowing. This can result in dehydration or weight loss. If the patient has lost more than 10 lbs without dieting, one must consider that the swallow is somehow impeded enough to cause diminished eating or drinking. With an accurate diagnosis of dysphagia (if that is the cause of the weight loss), and implementing an effective dysphagia management plan, the patient can begin to rehabilitate the weight loss by being able to ingest enough food and liquid to maintain adequate nutritional status.

Discharged from Acute Care directly to home within last month

Being discharged to home directly from a hospital or a sub-acute level of care raises the risk of dysphagia because of the fragility of the patient. What that means is that one neecds to be extra careful about food and liquid textures, positioning, reflux precautions etc. Going home doesn't necessarily mean that the patient should return to normal, whatever that was. Treating your body with extra care assists with the stabilization and healing from the acute incident

Discharged from Acute Care to another level of care and then to home within last six months

Residing in a sub-acute facility, rehabilitation hospital, or skilled nursing facility can be the bridge between the acute illness and healing at home. Remembering that the patient was supervised 24/7 in these facilities is important because now that they are living at home, in and ALF or an Independent Living Community, the patient and/or caregiver must be in charge of their own safety at least a majority of the time. Knowing how to manage your dysphagia risks is vital to continued healing and reduction of risk of returning to the hospital with an exacerbation of the acute illness or co-morbidity.

Live alone without spouse or live-in caregiver

A patient who is lucky enough to live at home or in an independent living community with their spouse or caregiver has a built in reduction of risk. The patient that lives alone assumes the entire burden of safety with managing their dysphagia. This patient benefits from working with the Speech Pathologist to design a care plan that takes this living situation into account. We don't all feel the same all day, every day, and knowing that is important as there will be times that the patient is too tired or doesn't feel well enough to prepare meals or abide by the snacks in the consistency recommended. Because of this, it is necessary to plan for such eventualities. The SLP will work with you to overcome this potential risk.

Has an aide/housekeeper that comes into home daily

Some situations require or benefit from having an aide or housekeeper come into the home or living environment daily. It is vital that this person also be involved in the care of the patient, whether it is simply to prepare food or liquid for the day, or to assure that the shelves are stocked with appropriate groceries for continued recovery. Simple tasks may be developed or reviewed with the SLP to assure that every possible reduction of risk is managed.

Has an aide/housekeeper that comes into home weekly

Depending on the level of dysphagia and risk of return to hospital, having a housekeeper or aide come in once or twice a week is better than nothing if the patient lives alone. The SLP would want to coordinate with the aide/housekeeper to try and get as much organized for the patient as possible so that the risk is reduced with coordinated care.

Are in charge of at least one meal prep per day

The patient that is in an alf or independent living community, and is in charge of getting one meal per day or more, has increased risk of noncompliance to dysphagia management. It is manageable, but may take some coordination with whomever is in charge of grocery shopping to assure that easy prep is possible in the correct consistency and nutritional values. Just one meal per day with inappropriate diet can increase risk significantly. Conversely, attention to this detail can decrease risk significantly with effective communication between the therapy team and patient's family.

Eats at least one meal prepared by a facility or aide/caregiver per day

Eating at least one meal per day prepared by the facility or aide/caregiver can decrease risk significantly when they are informed, trained, and compliant to the patient's needs.

Have been recommended for an altered diet – liquids only - to increase safety

When a patient needs an altered liquid consistentcy, sometimes only temporarily during the rehabiliatation process, this is indicative of increased dysphagia risk of aspiration or choking. Adherence to this recommendation during the rehabilitation process increases the liklihood of recovery and reduced risk of aspiration, congestion, pneumonia, etc associated with dysphagia.

Have been recommended for an altered diet – liquids and food - to increase safety

When a patient needs an altered food consistentcy, sometimes only temporarily during the rehabiliatation process, this is indicative of increased dysphagia risk of aspiration or choking. Adherence to this recommendation during the rehabilitation process increases the liklihood of recovery and reduced risk of aspiration, congestion, pneumonia, and choking as associated with dysphagia.

GERD Diet to reduce reflux recommended

Gastroesophageal Reflux Disease, Reflux, LPR, Respiratory Reflux, or any other name for the acid in the stomach coming back up into the pharynx and falling into the airway, increases risk of complications significantly. Reflux Dysphagia recommendations should be taken seriously as the potential for rehabiliation of the swallowing process and reduction of risk significantly improves with compliance. Since 50% of reflux may be silent, the patient may not realize how important this is to the recovery process.

Medications are set up by nursing/aide/caregiver

Whether one is receiving Home Health Care or is living at home or in a residential community, medications may be set up by a nurse, the aide, or a caregiver. When the patient does not feel well, confusion on when, how, and with what liquid consistency medication should be taken may be an issue. Within the dysphagia management plan, medication ingestion is a vital part of the process. Healing requires attention to detail and this is a very important detail indeed.

Lives at Home / Independent Living

Where one lives has an effect on how one recovers. Living at home or in an independent living community requires that the patient, caregiver, or aide takes on responsibilities for care that can mean the difference between a healthy outcome and complications from non compliance to care instructions. Living at home or in an independent living situation must also take into account how the coordination of care is going to occur. Having a good plan of care is vital to rehabilitative success.

Lives in Assisted Living

Where one lives has an effect on how one recovers. Living in an assisted living facility assumes that the patient is going to have help with the basics of care. One must realize that there are differing levels of assisted living, and one must check out exactly what is provided for each patient and compare that to the immediate needs. For example, how many meals are provided, are all medications provided by nursing, is an aide avaialable most days, or even who does the grocery shopping for those meals not provided? Where and in what level of care one lives makes a difference according to the patient's specific needs.

Lives in a Nursing Home

The patient that lives in a nursing home is assumed to have 24/7 supervision and care provided according to the patient's needs. Asking all the right questions prior to admission is vital to recognizing the level of care this specific nursing home provides. Do not assume anything. Ask.

Dysphagia management and risk of return to hospital is directly correlated with the level of care that the patient receives. Your SLP in the facility should be your biggest advocate for dysphagia management that is effective in stabilizing the patient after an accute episode of illness, and guides the patient toward rehabilitation and a healthier future.

Immobile without 100% assistance

Being immobile without assistance automatically increases risk because of the inability of the patient to do for themselves, and the reduction of air moving through the lungs in a natural cleasing action as when one is walking and moving. Whether it is temporary or part of the ongoing disease, managing the patient's dysphagia while anticipating the issues that can arise from being immobile are vital. The staff, caregiver, spouse, or SLP should be the biggest advocate for this patients needs for positioning for meals, manipulating the food or liquid, and reducing risk with techniques and compensatory strategies.

Needs assistance with mobility for some situations

The patient that needs assistance with mobility for some situations should be evaluated for increased risk, if any, according to the patient's particular dysphagia management recommendations. Working with PT, OT and SLP during the rehabiliative process is vital to reducing risks associated with positioning and adherence to compensatory strategies and diet modifications.

Communicates wants and needs with 75% or more efficiency

Communication is vital to rehabilitation success. The patient that is communicative successfully has a reduced risk of complications simply because understanding what to do and how to do it, making one's needs known, and providing vital feedback are vital to rehabiliation success.

Communicates wants and needs with less than 50% efficiency

Reduced communication, for whatever reason, increases the risk of complications simply because understanding what to do and how to do it, making one's needs known, and providing vital feedback are all vital to rehabilitation success. Addressing alternatives to reduced communications skills may be warranted.

Is in charge of all decisions and aspects of daily life

When one is in charge of all decisions and aspects of daily life, it is vital to understand whether that reasoning and judgement is functional for dysphagia management. Have you ever heard the phrase "you don't know what you don't know"? That applies to dysphagia management because when one has not had this issue before, and may not recognize the signs and symptoms of complications from dysphagia, their decisions may not be as positive toward rehabiliation as they could be. Working with the SLP to understand and then make decisions is the key to successful rehabiliation and feeling as good as possible.

Is driving alone

The patient that is driving onesself to the therapy sessions, drives alone on errands or trips, and does not consider the risk involved following an illness, should have a discussion with the SLP. Finding ways to do simple things like making sure the snacks you eat while driving are not a choking or aspiration risk, or reducing distractions while driving, may be beneficial to the patient. Reasoning and judgement that are a part of driving alone are also a part of the rehabiliation process. The SLP is here to help you succeed in both!