Online Therapy for Dysphagia

Chloe Brown, Speech Pathologist

What is dysphagia?

Dysphagia is the medical term to describe difficulties with swallowing. It is an impairment in swallow function causing difficulty with eating and drinking. Signs of dysphagia may include:

  • Difficulty chewing or breaking down food
  • Drooling when eating and drinking
  • Feelings of food being ‘stuck’
  • Coughing or choking when eating or drinking
  • Wet/gurgly vocal quality when eating or drinking
  • Frequent chest infections. 
  • Feelings of choking or regurgitation

Dysphagia may be caused by brain injury or stroke, progressive neurological diseases (e.g. parkinsons), developmental disabilities or diseases that may affect cognition, breathing or cause weakness and difficulty coordinating the muscles of the mouth and throat. 

How can a speech pathologist help with dysphagia?

A speech pathologist can help with dysphagia by identifying what is causing the person difficulty and providing strategies or recommendations to improve swallowing safety. If dysphagia is not managed appropriately it can lead to choking (food or drink blocking the airway), aspiration (food, drink or saliva entering the lungs rather than the stomach) or significant weight loss. 

A speech pathologist may provide recommendations to modify food and drink so that it is easier and safer to swallow, provide strategies for eating and drinking (for example changing position when eating, taking smaller mouthfuls etc) and provide exercises targeting the muscles in the face and neck used for swallowing. 

Can therapy for dysphagia be done online?

Therapy for dysphagia can be completed online. A speech pathologist is able to provide assessment, recommendations and prescribe dysphagia therapy through telehealth. During online sessions a speech pathologist can develop an understanding of the breakdown of swallow function by discussing with the client and watching them eat and drink and provide recommendations and therapy based on this.

It is important when managing dysphagia to ensure safety is a priority at all times. This may mean ensuring that a support person is sitting with the person with dysphagia during telehealth sessions when trialling different food or drink. It may also mean the online speech pathologist recommending further assessment of the persons swallowing internally via xray or endoscope which they can review and provide recommendations on post assessment. 

Is online therapy as effective as face-to-face?

Yes, a growing body of evidence shows that online delivery of therapy can be as effective as face-to-face.

Are there any things that can’t be done online?

A speech pathologist may recommend an instrumental swallowing assessment to further investigate swallow function from an internal perspective. This may include either a videofluroscopy swallowing study (a moving xray taken while the person eats or drinks to follow the path of food or drink) or fibreendoscopic evaluation of swallowing (a camera inserted through the nose and placed at the back of the throat to watch the person eat and drink and view their anatomical structures). These assessments can not be completed online as they need to be completed in a hospital or clinic with the appropriate equipment and require a referral from a GP. However, following these assessments an online speech pathologist can recommend appropriate diet and fluids and swallowing exercises based on the results of this assessment. 

What is involved in online therapy for dysphagia?

A speech pathologist will complete an initial consultation to discuss the person’s eating and drinking and identify the symptoms of dysphagia by investigating what may be harder to swallow. They will complete an online assessment which usually involves asking about eating and drinking, typical mealtime routines and areas of concern etc. The speech pathologist may then complete an assessment to determine how well all the muscles and nerves of the face, mouth and neck are working which will involve a few short exercises. They will then observe the person eat and drink and identify the areas of difficulty. A speech pathologist may recommend certain modifications to the person’s current diet and fluids to improve the person’s swallowing safety. 

Once the area of swallowing difficulty has been identified, a speech pathologist may recommend certain exercises to improve the person’s swallowing efficiency or strengthen the person with dysphagia’s muscles used for swallowing. A speech pathologist will create a mealtime management plan with tailored swallowing strategies to enhance the person with dysphagia’s safety when eating and drinking. This management plan may change over time and the speech pathologist will continuously review this plan.