Swallowing and Dysphagia: A Comprehensive Guide for Speech Therapists
Swallowing is the act of transporting food and liquids from the mouth to the stomach. Dysphagia refers to swallowing disorders, which can have serious consequences (aspiration, malnutrition, pneumonia). The speech therapist plays a central role in the assessment and management of these disorders, in collaboration with the medical team.
🍽️ Download our swallowing tools
Texture chart, meal supports, oro-facial praxia exercises
Access the tools →📋 Table of Contents
Physiology of Swallowing
Normal swallowing is a complex process involving more than 30 muscles and 6 cranial nerves. It is divided into three main phases, each of which can be the site of difficulties.
1️⃣ Oral Phase (Voluntary)
Oral Preparation: chewing, salivation, formation of the food bolus. The tongue gathers the food and positions it.
Oral Transport: the tongue propels the bolus to the back of the mouth. This phase is under voluntary control.
Duration: variable depending on the texture (1-2 seconds for liquids, longer for solids).
2️⃣ Pharyngeal Phase (Reflex)
Automatically triggered when the bolus reaches the pillars of the soft palate. The swallowing reflex causes:
- Closure of the soft palate (prevents nasal reflux)
- Elevation of the larynx and tilting of the epiglottis (protection of the airways)
- Closure of the vocal cords
- Contraction of the pharyngeal muscles (propulsion to the esophagus)
- Opening of the upper esophageal sphincter
Duration: about 1 second. Critical phase for safety.
3️⃣ Esophageal Phase (Reflex)
Transport of the bolus by peristaltic waves from the esophagus to the stomach. Opening of the lower esophageal sphincter.
Duration: approximately 8-10 seconds.
What is Dysphagia?
Dysphagia is a swallowing disorder that can affect one or more phases. It can involve solids, liquids, or both. The consequences can be serious:
- Aspiration: passage of food or liquids into the airways
- Inhalation Pneumonia: lung infections related to repeated aspiration
- Malnutrition: insufficient intake due to fear or difficulty eating
- Dehydration: insufficient fluid intake
- Impact on Quality of Life: social isolation, anxiety at mealtimes
⚠️ Medical Emergency
Aspiration with choking, repeated pneumonias, or severe malnutrition requires urgent medical management. The speech therapist always works in collaboration with the medical team.
Causes and Affected Populations
| Population | Common Causes |
|---|---|
| Newborns/Infants | Prematurity, sucking disorders, malformations (cleft), neurological impairments |
| Children | Cerebral palsy, neuromuscular diseases, oral disorders, malformations |
| Adults | Stroke, traumatic brain injury, ENT cancers, Parkinson's, ALS, MS, surgeries |
| Older Adults | Presbyphagia (aging), dementias, strokes, medication effects |
Types of Dysphagia by Location
- Oral Dysphagia: difficulties in chewing, preparation, or propulsion of the bolus
- Pharyngeal Dysphagia: delay or absence of reflex triggering, aspiration
- Esophageal Dysphagia: sensation of blockage, regurgitation
Warning Signs
During Meals
- Coughing during or just after meals
- Wet or "gurgly" voice after swallowing
- Blockages or sensation of "it won't go down"
- Drooling or difficulty holding food in the mouth
- Prolonged or ineffective chewing
- Food residues in the mouth after swallowing
- Nasal reflux
General Signs
- Unexplained weight loss
- Repeated lung infections
- Avoidance of certain textures or food refusals
- Very long meals (fatigue, slowness)
- Anxiety or stress around meals
💡 Silent Aspirations
Warning: some aspirations are "silent" (without coughing) and therefore difficult to detect. They are common in people with neurological impairments and are particularly dangerous. A changed voice after swallowing may be the only sign.
Swallowing Assessment
Speech Therapy Assessment
- Anamnesis: medical history, complaints, problematic textures
- Examination of Structures: lip, tongue, velar mobility, sensitivity
- Meal Observation: behavior, posture, duration, textures
- Food Trials: different textures and volumes, with monitoring
- Functional Capacity Test: water glass test
Complementary Examinations (Medical)
- Videofluoroscopy (radiocinema): real-time visualization of swallowing
- Nasofibroscopy: direct examination of the pharynx and larynx
- Manometry: measurement of esophageal pressures
Speech Therapy Management
Environmental and Positional Adaptations
- Position: sitting upright, chin slightly tucked
- Environment: calm, without distractions, no conversation during ingestion
- Small Quantities: adapted spoon, small bites
- No Straw (difficult to control the flow)
Texture Adaptation
| Texture | Description | Examples |
|---|---|---|
| Thickened Liquid | Syrup, honey, or cream consistency | Gelatinous water, thick soup, smoothie |
| Smooth Puree | Homogeneous, without chunks | Fine puree, applesauce, velouté |
| Chopped | Small soft pieces | Ground meat, mashed vegetables |
| Soft | Melt-in-your-mouth pieces, easy to crush | Fish, eggs, ripe fruits |
| Normal | All textures | Standard diet |
Rehabilitation
- Strengthening Exercises: lips, tongue, soft palate
- Sensitivity Work: thermal, tactile stimulations
- Protection Maneuvers: supraglottic swallowing, effort
- Coordination Work for Breathing and Swallowing
Our Downloadable Swallowing Tools
📊 Texture Chart
Classification of food textures with examples. Guide to adapt meals.
Download👅 Oro-facial Praxia Exercises
Movements of the tongue, lips, and cheeks. Strengthening of oral musculature.
Download🍽️ Meal Supports
Visual guidelines for posture and adaptations during meals.
Download📋 Food Diary
Tracking meals, tolerated textures, observed difficulties.
DownloadFrequently Asked Questions
Not necessarily. The adaptation of liquids depends on the type and severity of dysphagia. Some people have difficulties only with clear liquids (water, juice) but tolerate thickened liquids well. Others have difficulties with all consistencies. Speech therapy assessment allows for determining the necessary adaptations for each person.
It depends on the cause. After a stroke, dysphagia often improves significantly in the weeks to months following due to neurological recovery and rehabilitation. In neurodegenerative diseases (Parkinson's, ALS), the goal is rather to maintain abilities as long as possible and to adapt. Speech therapy improves safety and comfort in all cases.
The prescription of a modified texture diet is a medical act. The speech therapist assesses swallowing capabilities and makes recommendations, but it is the physician who officially prescribes the adapted diet. In institutions or hospitals, a multidisciplinary team (physician, speech therapist, dietitian) collaborates to define adaptations.
🍽️ Ready to work on swallowing?
Discover all our free tools to support swallowing disorders
See all tools →
