Swallowing Difficulties

Do you have trouble swallowing?

Dysphagia
Dysphagia is the medical term for difficulty swallowing and is a symptom of many different medical conditions. These conditions include nervous system and brain disorders, muscle disorders and physical blockages in your throat.

Someone with Dysphagia has a hard time swallowing foods and/or liquids without having them “go down the wrong pipe”.

Dysphagia is not a disease; it is a condition that results because of another condition or a disease.
Some of the common reasons why someone might develop Dysphagia include; mouth or throat cancer, having a stroke, nerve disorders like ALS, Parkinson’s, multiple sclerosis, etc.) or dementia like Alzheimer’s (forgetting how to swallow).
Dysphagia could be short term or it might be a life-long problem.

* Treatment for swallowing issues may include medications, changes to your eating habits and, sometimes, procedures.

From the feeding prespective, we can help you!

* Please, answer the following questions and check all symptoms that applies and click submit. Our assitant will contact you soon!
Describe your medical history and how long have you experienced problems swallowing or chewing?*
1 - Difficulty managing a solid bolus

Cannot bite off a piece of solid foodDoes not chew solidsChews very slowlyAvoids solid foods requiring chewingFood particles fall ‘all over’ mouthPocketing of foodDifficulty moving bolus to the back of the mouthTakes a long time to swallowExtra oral loss (food or liquid falling out)Coughing or gagging before, during or after a swallowWet voice quality after the swallowHoarse voice after the swallowResiduals in oral cavity after the swallow
2 - Difficulty managing a liquids bolus

Inability to extract liquids from a strawExtra oral loss (food or liquid falling out)Takes a long time to swallowCoughing before, during or after the swallowWet voice quality after the swallowHoarse voice after the swallowOther
3 - Other reason

Nasal regurgitationDifficulty in managing oral secretionsGets distracted from eating / needs to be reminded food is in mouthDifficulty taking oral medicationsInability to maintain upright or semi-reclined positionInability to maintain neutral head positionTeeth or dentures are missing or not alignedComplains of pain or discomfort when swallowing
Medications & dosages (Type/frequency). List all over the counter medicines, include vitamins, minerals and herbals.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
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Email*
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Language spoken other than english
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Do you have trouble swallowing?