Assessment of dysphagia is the responsibility of an appropriately trained Speech and Language Therapist (SLT) and will include other members of the multidisciplinary team.  The assessment process will consider:

  • The person’s medical history, including the Acquired Brain Injury and history of chest infections. Pre-existing health problems that may impact upon safe eating and drinking will also be considered (e.g. Asthma, Chronic Obstructive Pulmonary Disease, previous brain injuries etc).
  • Weight, current nutritional state and nutritional requirements.
  • Physical abilities relating to eating and drinking. This includes posture, head and limb control and the functioning of the muscles involved in eating, drinking and swallowing.
  • Any physical problem that may have an impact on safe and effective eating, drinking and swallowing (e.g. ill fitting dentures, oral hygiene, trauma to the face, mouth and throat, presence of a tracheostomy, visual impairment).
  • Oral control of saliva, significant quantities of saliva retained in mouth without being swallowed and/or uncontrolled loss of saliva from mouth/drooling.
  • Voice quality.
  • Changes in sensation affecting the lips, mouth and throat.
  • The impact of fatigue.
  • Levels of alertness and ability to co-operate.
  • The person’s experience and perception of the problem. Information regarding this may be obtained by direct discussion with the person and/or by seeking information from families and carers etc.
  • The presence of cognitive, communicative and behavioural difficulties that may be impacting upon the person’s ability and safety.
  • Psychological and psychiatric problems.
  • Medication that may be affecting the person’s ability to take adequate nutrition safely.

The SLT will also directly assess the person’s ability to take fluids and food.  This will include trials of foods and fluids of different types and textures and may also include observation of how the person manages at mealtimes.

Following initial assessment, referral may be made for:

  • Videoflouroscopy (modified barium swallow – a dynamic moving x-ray taken as the person eats and drinks).
  • Fibreoptic endoscopic evaluation of swallowing (FEES) – insertion of a narrow tube via the nose into the throat. The tube contains a light and camera to enable the assessor to observe the throat whilst the person eats and drinks.

If the person is found to be dysphagic, the Speech and Language Therapist, in liaison with other members of the multi-disciplinary team will then formulate a dysphagia management plan.  This will consider several factors:

If dysphagia is so severe that oral nutrition would be severely detrimental to the person’s health (the risks to health and safety are too severe and the person is unable to safely take adequate nutrition orally) the decision should be made whether the person is suitable for alternative methods of receiving nutrition i.e. enteral nutrition.  This may include insertion of a nasogastric (NG) tube or a percutaneous endoscopic gastrostomy (PEG) tube.

Enteral nutrition will deliver food in liquid form directly to the stomach or upper intestine.  Although enteral feeding does not eliminate all risk of aspiration, it does enable the patient with severe dysphagia to obtain adequate nutrition which can support rehabilitation, wellbeing and quality of life.

It is important that the person with dysphagia is reassessed regularly if:

  • They are in the early stages of rehabilitation.
  • They are making progress in rehabilitation and getting stronger.
  • There is deterioration in eating and drinking abilities.
  • They have repeated chest infections.
  • They are coughing/choking regularly whilst eating/drinking or there is an increase in signs that may indicate a person has dysphagia.
  • They are losing weight.
  • There are any further concerns relating to the person’s ability to take food/fluids safely.

 

Any changes in the characteristics of dysphagia should lead to a review of the dysphagia management plan.