Humans love and live to eat!

Swallowing is one of the very first acts that a human child elicits in its lifespan. Since swallowing is acquired very early and easily, it is taken for granted many a times. But very few know that a highly complex neural network is triggered in order to carry out a single swallow.

The lips, tongue, jaw, soft palate and pharyngeal wall are used to bring about a swallow. Undeniably, these are the same set of muscles used while speaking. Hence it is very commonly seen that speech and swallowing functions both are hampered as a sequel of one another.

As discussed under the title of “Speech Disorder” in MND/ALS, oral muscles are affected. As an effect, the oral muscles (specially tongue) are unable to push the food posteriorly into the food pipe, hence creating a risk for food to enter the airway. Food entering the airway (lungs) is clinically known as “aspiration”.

CLINICAL FEATURES

Some of the signs of swallowing problems are:

• Inability to chew food properly
• Frequent cough while eating
• Eye watering/ eye reddening while eating Feeling of breathlessness while eating Effortful swallow
• Increased meal time with reduced meal intake
• Sudden weight loss
• Feeling of something stuck in throat
• Spilling out of food from corners of mouth
• Wet voice quality

MANAGEMENT

After a detailed swallow examination, the Speech Language Pathologist (SLP) will prescribe the patient with certain patient-specific techniques, manoeuvres and exercises and may also suggest an alteration in the type of consistency that is safe for the patient.

Some of the therapeutic management are:

1) Oro-motor exercises: These exercises work on

• Jaw opening
• Tongue protrusion
• Tongue elevation and depression
• Tongue lateralisation

2) Manoeuvres to improve swallowing

3) Techniques to reduce risk of aspiration: The SLP will prescribe patient specific “Safe Swallow Techniques” in order to reduce risk of aspiration.

Swallowing therapy is mainly divided into two parts:

a) Restorative exercises: These exercises mainly help to restore the function of the muscles which may have been weakened.

b) Compensatory techniques: The SLP recommends these techniques when the muscles have reached the maximum recovery stage and/or the further recovery may be very slow. These techniques thus help the patient to start having oral feeds safely and comfortably even while the muscles are in the process of recovery. While eating or drinking the patient should have position of 90⁰ upright sitting with the head low, chin tuck and slightly kneeling forward.

Compensatory techniques

1. Chin-Tuck Technique

b) Head Tilt Technique

c) Head-Turn

d) Mendelsohn’s Maneuver

EXERCISES TO BE DONE

a) Chin-Tuck Against Resistance

b) Masako Maneuver

c) Shaker’s exercise

d) Passive Shaker’s exercise

4) Alteration of type of consistency: The SLP along with the Dietician will prescribe the patient with an alteration of food consistency if required in order to preserve the safety of the airway. At all times, care will be taken that the patient’s nutrition and hydration is maintained even through with prescribed alternative diet.

5) Active monitoring of weight: Any weight loss encountered by the patient will be targeted by both the SLP and Dietician. The SLP will provide the patient with swallowing strategies which will reduce fatiguability caused to the patient while eating and hence increase food intake.