SPHY301: Swallowing, Feeding, and Mealtime Difficulties

• SPHY301 is about "Swallowing, Feeding and Mealtime Across the Lifespan"

Objectives of this 'Snack Bite'

• Define swallowing, feeding, and mealtime difficulties (LO1, LO2).
• Broadly describe the role of speech pathologists in managing these difficulties (LO3).
• The Clinical Dysphagia Guidelines from Speech Pathology Australia (2012), is a useful document for introducing current scope of practice in dysphagia management, but is currently under review.

Swallowing Difficulty

• Dysphagia refers to difficulty or inability to swallow, a frequent term used in speech pathology discussions.
• Dysphagia can occur across the lifespan and coexist with feeding difficulties.
• Dysphagia is a symptom of an underlying medical or physical process that can be neurological, structural, or psychological.

Dysphagia as a Symptom

• Genetic factors like cleft lip/palate can cause dysphagia.
• Developmental factors like prematurity consequences can cause dysphagia.
• Acquired conditions like brain injury, stroke or cancer can cause dysphagia.
• Dysphagia can be caused by functional unknown causes.
• Iatrogenic factors during treatment, can cause dysphagia as a side effect of surgery or birth trauma.
• Structural impairment (e.g. cleft palate, hemiglossectomy).
• Physiological (e.g. reflux).
• Neurological impairment (e.g. stroke, brain injury).
• Dysphagia can be seen as impaired oral preparation, oral phase, pharyngeal or oesophageal phase function.
• Dysphagia can be seen as impaired swallow-respiratory coordination.
• Dysphagia can be seen as impaired ability to protect the airway.

Flags for Dysphagia

• Difficulties sucking, swallowing, drinking, chewing, controlling saliva, taking medications, or protecting the airway are indicators of dysphagia.
• Pocketing of food/fluid in cheeks and reduced tongue and mouth movements can be a sign of dysphagia.
• Oral spillage, nasal regurgitation, absence or weakness of a voluntary cough, are indicators of dysphagia.
• Coughing with oral intake, tongue thrust, or primitive oral reflexes can be a sign of dysphagia.
• Changes in vocal quality, like a moist, gurgly voice or frequent throat clearing, can be indicators of dysphagia.
• Changes in respiration while eating/drinking, extended mealtimes, fatigue, changes in eating habits, and poor oral hygiene can be indicators of dysphagia.
• Temperature spikes can indicate dysphagia.

Feeding Difficulty

• Feeding difficulty is the difficulty moving food/fluid to the mouth.
• Considerations include postural weakness, weakness or changes in coordination of hand/arm.
• Consider sensory loss, cognitive changes.
• Feeding and mealtime difficulties are sometimes used synonymously with swallowing difficulties, but there is a distinction.
• Feeding is an aspect of assessment and management, that deals with the skills of the client and the person assisting them with their meal.

Mealtime Difficulty

• Individuals with mealtime support needs have difficulty eating or drinking, possibly due to dysphagia or feeding difficulties, stemming from motor, sensory, cognitive, emotional, or behavioral issues.
• An impoverished mealtime environment can negatively impact physical or social participation during mealtimes.
• Consideration must apply to complexity and interplay between medical, nutritional, and psychosocial needs surrounding mealtimes, requiring a view of the entire mealtime.
• Requires considering swallowing, feeding skills, feeding assistance provided, psychosocial needs, meaning of mealtimes, and the physical/social mealtime environment.

Consequences of Swallowing, Feeding, and Mealtime Difficulties

• Unmet nutritional and hydration needs
• Medical complications such as aspiration pneumonia, immunosuppression, skin breakdown, and poor oral hygiene are potential consequences.
• Increased dependency, longer hospital stays, and various care options are activity-related consequences.
• Medications, social isolation, mental health issues, and strained carer/child relationships are participation-related consequences.

Role of Speech Pathologists

• Speech pathologists play a pivotal role in managing swallowing, feeding, and mealtime difficulties for children and adults.
• Speech pathologists manage neurological conditions like acquired brain injury and degenerative diseases.
• Speech pathologists manage structural conditions like head and neck cancer and tracheostomy.
• Speech pathologists mange respiratory conditions.
• Speech pathologists manage neurologics disorders e.g CP.
• Speech pathologists manage developmental disabilities, e.g. down syndrome.
• Speech pathologists work with prematurity, autism spectrum disorders and craniofacial anomalies.
• Environmental issues are addressed by speech pathologists.

Practice Settings

• Hospitals, outpatient clinics, neonatal intensive care units (NICU), multidisciplinary feeding clinics, movement disorders clinics, and VFSS clinics are common work places.
• Stroke units, intensive care units (ICU), aged care facilities and rehabilitation centers are common work places.
• Speech pathologists also work in residential care, private practice, disability-specific service providers, NDIS, and schools.

Collaboration

• Speech pathologists work within multidisciplinary, interprofessional, or transdisciplinary teams due to the complexities of these difficulties.
• Speech pathologists may collaborate in clinic settings or through telehealth, working with medical practitioners such as neurologists, pediatricians, and gastroenterologists and allied health professionals like PTs, OTs, and dietitians.
• Speech pathologists collaborate with nursing staff, dentists/dental hygienists, kitchen staff, carers, and educators.

Frameworks and Scope

• Practice is guided by established frameworks like E3BP, ICF, and person-centered care.
• Research supports the benefit of speech pathology input as part of a team approach to managing swallowing, feeding, and mealtime difficulties.
• Expanded and advanced scope of speech pathology practice such as FEES can occur.
• Speech pathologists help others with eating and drinking with acknowledged risk.