Can speech therapy treat dysphagia (swallowing disorder)?

Speech Therapy is Effective for Treating Dysphagia

Speech therapy is highly effective for treating dysphagia (swallowing disorders) and should be recommended as a first-line treatment approach for patients with swallowing difficulties. 1

Evidence for Speech Therapy in Dysphagia Management

Speech-language pathologists (SLPs) play a crucial role in the evaluation, diagnosis, and rehabilitation of dysphagia. The evidence supporting their role includes:

Assessment Process

• Standardized assessment of swallowing function should be performed before oral feeding is initiated, especially in patients with tracheostomy 1
• Diagnostic tools include:
  • Bedside swallowing examinations
  • Fiberoptic endoscopic evaluation of swallowing (FEES)
  • Videofluoroscopic swallow studies 1, 2

Therapeutic Approaches

Speech therapy for dysphagia includes several evidence-based techniques:

1. Compensatory Strategies:

   • Postural changes (e.g., chin-down posture)
   • Bolus modification (adjusting food consistency)
   • Swallowing maneuvers 1

2. Rehabilitative Exercises:

   • Expiratory muscle strength training (EMST) - improves cough and swallow function 1
   • Oral motor exercise programs - increase strength and range of motion of the mouth, larynx, and pharynx 1
   • Shaker head lift exercises - improve strength of suprahyoid muscles and upper esophageal sphincter opening 1
   • Lee Silverman Voice Treatment - improves neuromuscular control during swallowing 1

3. Sensory Enhancement Techniques:

   • Thermal-tactile stimulation - can improve swallow timing 1
   • Enhanced sensory input during feeding 3

Effectiveness of Speech Therapy for Dysphagia

Recent evidence demonstrates significant positive outcomes from speech therapy interventions:

• A 2025 retrospective cohort study found that completing a 7-8 week course of exercise-based outpatient swallowing therapy led to:

  • Improved swallowing physiology
  • 49% reduction in aspiration risk
  • 44% improvement in swallowing efficiency
  • Ability to advance to less restricted diets 4

• Systematic exercise protocols like the Systematic Exercise for Treatment of Swallowing (SETS) have shown measurable improvements in pharyngeal impairment scores and reduced aspiration risk 4

Specific Populations Benefiting from Dysphagia Therapy

Speech therapy for dysphagia is particularly beneficial for:

1. Neurological Conditions:

   • Parkinson's disease - exercise programs have demonstrated improvement in penetration/aspiration scores 1
   • Post-stroke dysphagia - improves swallowing safety and feeding status 1
   • Post-intensive care syndrome (PICS) 1

2. Head and Neck Conditions:

   • Pharyngoesophageal dysphagia 2
   • Patients with tracheostomy tubes 1

3. Functional Disorders:

   • Functional dysphagia 1

Treatment Duration and Approach

• Typically 1-2 therapy sessions weekly for 4-8 weeks, with duration determined by symptom severity 2
• Success depends heavily on patient commitment to practicing techniques outside therapy sessions 2
• Most insurance plans, including Medicare, cover voice and swallowing therapy if provided by a certified SLP 2

Potential Limitations and Considerations

• Not all dysphagia interventions have the same level of evidence; some techniques have stronger research support than others 5
• Patient selection is important - those who are motivated, moderately alert, and have some degree of deglutition are appropriate candidates 6
• Medication side effects (particularly from neuroleptics) should be considered as potential causes or aggravating factors for dysphagia 7

Speech therapy represents a non-invasive, evidence-based approach to dysphagia management that can significantly improve swallowing function, reduce aspiration risk, and enhance quality of life for patients with swallowing disorders.