DMS@Home

Having dysphagia can result in symptoms that are obvious, such as congestion, bronchitis, pneumonia, coughing, choking, and infection. Statistically having dysphagia accounts for between 13 and 48% of all infections in a residential setting (Langmore, Terpenning, Schork, 1998).

Having dysphagia can also result in symptoms that are subtle such as dehydration, chronic cough, increased asthma symptoms, a weak, wet or gurgly voice, throat clearing, fatigue, difficult diabetes control, increased symptoms of COPD, loss of appetite, loss of interest in eating, and weight loss.

This list is not complete as every person may have subtle symptoms related to their particular conditions.

Dysphagia is caused by something, whether it be an injury, medical condition, surgery, treatment or disease. Depending on the cause of your dysphagia, it may be temporary or it may be a chronic condition that can be managed with appropriate diet modifications and techniques. Knowing what is causing your dysphagia is vital to your recovery, as once we know how to treat and remediate the problem, healing may be able to begin. This is the most difficult part of the process. A typical patient of the DMS Speech Pathology Dyspahgia Expert has seen an average of 7 healthcare professionals in an attempt to figure out why they are having problems. Consulting with an expert in dysphagia, such as with the DMS Speech-Language Pathologist is a positive first step.

DMS works with your physician or physicians in order to manage your care. You do not need an initial referral in order to be evaluated by DMS, although we will be contacting your physician to review your condition and evaluation findings. In this way we can, together, manage your dysphagia in the most medically appropriate manner. We will keep your physician in the loop throughout your therapy sessions to assure that you are getting the most appropriate care available.

The first step in helping you to feel better and relieve your dysphagia symptoms is to have a comprehensive evaluation so that the source of your dysphagia can be identified. Realizing that there are Five Systems of Dysphagia, it is imperative that those systems are individually evaluated to begin the process. This is done in two sessions:

The First session is a comprehensive speech-language-dysphagia evaluation. This can be done via TeleHealth at the DMS@Home Teletherapy site. The evaluation will take approximately one hour and will consist of a comprehensive review of everything from your medical history to the foods and liquids that you are ingesting. The DMS Speech Pathologist will walk you through the process. The more information we can gather, the quicker we can get your feeling better!
The second session in the process is to have a dysphagia instrumentation, or Dysphagia Systems Test (DST). This will be done in person either in one of our clinics, physician’s offices, or in your home (in states where this is allowed). This swallowing test is completed with food and drink that you may normally ingest, and results are immediate.

Following the comprehensive evaluation process, your DMS Speech-Language Pathologist will enroll you in several speech therapy sessions (5-10 sessions on average) in order to operationalize your dysphagia management plan within your living environment. During these session you will be given a food and liquid texture plan, techniques to improve safety and strength of swallow, and lifestyle review to assure that you are safe throughout the entire 24 hours of the day.

Prior to discharge, when you are feeling better and your dysphagia management plan is fully operationalized, you may have a follow up instrumentation if medically warranted, in order to assess whether or not you are ready to be discharged.

Following discharge, the DMS SLP is available for sporadic consultation if your condition changes and free support groups are available on the DMS@Home Teletherapy website. We want to assure that we are available to keep you on track with your dysphagia management plan, that you are still feeling better, and that your quality of life continues to improve.

This question is difficult to answer as each person’s individual situation is unique. Typically, DMS provides the diagnostic sessions and an average of 5-10 therapy session over the course of 6 months for its patients, to operationalize their individualized dysphagia management plan. The goal is for the patient to feel significantly better and to be able to manage their dysphagia care within their living setting and caregiver situation during this time. We realize that managing dysphagia may be an ongoing process and we attempt to empower the patient and caregivers to take control of the care with ongoing positive outcomes. We keep in touch with our patients in order to provide ongoing support, should their medical condition change in the future.

Every patient’s condition is unique. The concept of dysphagia care meaning that all food has to be blended is an antiquated idea. Depending on the patient’s swallowing abilities, dentition, and cognitive abilities, blending food may not be necessary. We find that for patients living outside of a nursing home, food textures can be modified appropriately without blending. This is because food and liquids can be prepared in individualized ways much easier for one person, than for all of the residents needing altered diets in a nursing home. The DMS Speech-Language Pathologist will work with your individual food preferences to help find textures that are safe.

Every patient’s condition is unique, and as such, each person’s needs must be individualized. Drinking liquids involves more than just thickness. What type of cup or glass is used is important, as well as techniques to safely ingest the liquids. There are liquids that are naturally thick that may be safer than thin liquids for some patients. There are products on the market that can thicken water, beer, wine, or soda without a change in taste and just a small change in consistency. Drinking the right consistency of liquid and reducing your dysphagia symptoms does not have to inconvenient or distasteful. Your DMS Speech-Language Pathologist will work with you to find the right consistency and help you figure out how to enjoy the drinks that you love!

Your DMS Speech-Language Pathologist will incorporate your swallowing instrumentation with FEES into your comprehensive diagnostic profile. This is the only medical instrumentation that is used by DMS to assess your swallow. The use of fiberoptic endoscopy to evaluate swallowing is a procedure that utilizes digital technology. In the DST(Dysphagia Systems Test), a fiberoptic laryngoscope is passed transnasaly (slides in along the floor of the nose) to the hypopharynx (back of the throat). At this point, the larynx and the surrounding structures can be viewed. The scope hangs quite high in the throat, behind the uvula (jiggles when you say, “Ahhh”) and does not pass far down into the throat or between the vocal folds. This procedure is not painful and feels like one is ‘picking their nose’, according to the majority of patient reports. Foods and liquids are then given to the patient, and the swallow is viewed over several consecutive trials. The entire endoscopic portion of the instrumentation normally lasts less than 10 minutes on average. A clinically privileged Speech-Language Pathologist performs the procedure according to the standards as set forth by the American Speech, Language and Hearing Association and State Law, and has been in the Scope of Practice for Speech Pathologists since 1992.
Click on this link to view the procedure.

The neurological system of dysphagia is responsible for the functioning of the nerves within your mouth and throat. These nerves alert your brain to the need to swallow when it perceives that food or liquid is on its way down into the throat. In order to swallow safely, your vocal cords have to close and your epiglottis retroverts down over your closed vocal cords in order to protect your trachea and lungs from having the food or liquid fall in during the swallowing process. When food and liquid fall through the open vocal cords and head down into the trachea and lungs, this is called aspiration. The nerves innervating this area alert the brain to the fact that something has fallen into an area that it shouldn’t, and as a result we cough to get whatever it is out of the airway. When those nerves are not working as they should for whatever reason, we don’t feel the food or liquid fall into the airway, and as a result there is no cough. This is called ‘silent aspiration’, meaning that the brain is not aware that it happened. Reflux is another method of aspiration. When we swallow food or liquid and it comes back up through the esophagus and into the pharynx ( throat ), and then falls into the airway through the vocal cords, we would normally cough to clear it out as it contains acid. This acid is very toxic and can burn the throat easily. If those nerves are not working, much like with aspiration of food or liquid, the brain would not perceive that the reflux has come back up into the throat and fallen into the airway. This is called silent reflux. According to the literature, 50% of reflux is silent because of the damage it has done to the structures of the throat with the consistent acid wash. Basically silent aspiration and silent reflux mean that you don’t know its happening, yet it can be significantly impacting how you are feeling. The DMS Speech-Language Pathologist is an expert in diagnosing what is going on and the DST identifies silent aspiration or silent reflux when it is happening. Our working with your doctor to medically manage this issue is paramount to your improvement in your dysphagia symptoms.

Dysphagia is a condition that is caused by something else. When you modify the triggers that are causing the increased symptoms of your dysphagia, your condition can improve. When you rehabilitate your swallow to improve your safety, your symptoms can diminish. When your dysphagia was caused by a condition that will improve and go away, or a result of surgery, chemo or radiation, you can manage it to stay safe until you recover from your primary disease. There are as many variations of causes as there are ways to keep you safe, functional, and feeling as good as possible. Can you live with dysphagia? Yes, you absolutely can live a functional and productive life while managing this condition. Knowledge is power, and the Speech-Language Pathologists at DMS are here to design a program that works for you and provide you with a path to improved comfort, care, and quality of life.