From the Guidelines
For delayed and malfunctioning oral phase initiation of swallowing, I strongly recommend adapting the texture of solid and liquids to facilitate swallowing and avoid aspiration, as well as using postural maneuvers such as chin-tuck posture to protect the airway during swallowing. When managing dysphagia in patients with conditions like ALS, it is crucial to consider the impact of muscular fatigue and long-lasting meals on swallowing function 1. Key strategies include:
- Modifying food texture to soft, semisolid, or semiliquid states to ease oral and pharyngeal transport 1
- Using thicker liquids or semisolid foods with a high water content, such as jellified water, as alternatives to thinner liquids to help alleviate aspiration 1
- Employing postural maneuvers like the chin-tuck posture, which has been shown to offer valuable protection for the airways by opening the valleculae and preventing penetration into the larynx 1
- Considering the use of instrumental studies of swallowing function, such as videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES), to guide the safety and efficacy of texture-modified diets 1 It is also important to note that patients experiencing appreciable levels of fatigue should be advised to eat several small meals a day, and dietetic counseling should focus on meal enrichment with high-calorie foods 1. Additionally, emphasizing taste or temperature can help enhance the triggering of the swallowing reflex 1. By implementing these strategies, patients with delayed and malfunctioning oral phase initiation of swallowing can reduce the risk of aspiration and improve their overall swallowing function.
From the Research
Delayed and Malfunction Oral Phase Initiation of Swallowing
To address delayed and malfunction oral phase initiation of swallowing, several approaches can be considered:
- Enhancing swallowing initiation through central interventions such as non-invasive brain stimulation (e.g., transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS)) and peripheral interventions (e.g., pharyngeal electrical stimulation (PES)) 2
- Exercise-based swallowing intervention, such as McNeill Dysphagia Therapy, with or without adjunctive neuromuscular electrical stimulation (NMES) 3
- Swallowing rehabilitation encompassing education, dietary modification, and swallowing exercises 4
- Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, to improve swallowing function and quality of life in patients with dysphagia 5
Assessment and Management
It is essential to conduct early screening and assessment, including videofluoroscopic swallowing, to determine the presence of dysphagia and develop an appropriate treatment plan 5. A comprehensive approach to management may include:
- Nutritional intervention and an oral care program 5
- Preventive swallowing exercise regimens to maintain oral intake throughout and following head and neck cancer therapy 4
- Dietary alterations and swallowing exercises as part of a holistic strategy for management 4
Treatment Outcomes
Studies have shown that exercise-based swallowing intervention, such as McNeill Dysphagia Therapy, can lead to significant improvements in clinical swallowing ability, oral intake, and patient perception of swallow 3. Additionally, swallowing rehabilitation and therapeutic methods can result in improved swallowing function and quality of life in patients with dysphagia 5, 4