Before a problem with swallowing can be explained, one should have an understanding of normal swallowing (the ability to swallow easily and trouble free).
Normal swallowing, also known as deglutition, can be divided into three areas or phases as follows:
Oral Phase – In this phase, the lips, tongue and teeth are used to chew the food and move it around in the mouth to form a ball or “bolus”. Once a nicely formed bolus is formed, it is then transported or pushed to the back of the tongue and a swallow is triggered. This phase of swallowing is voluntary since the individual is controlling the food inside the oral cavity or mouth.
Pharyngeal Phase – In this phase of swallowing, the movement of the bolus is no longer voluntary. The muscles are now controlling how the bolus moves from the back of the tongue and now down the pharynx or throat. In this phase, it is important that the larynx or voice box moves upward so that the airway is closed off by a flap called the epiglottis, preventing the bolus (food) from entering the lungs.
Esophageal Phase – Once again, this phase of swallowing is involuntary because the muscles are controlling the movement of the bolus. It is during this phase of swallowing or deglutition that the bolus is propelled down into the stomach by a series of muscle contractions known as peristalsis.
What happens when this perfect synchrony of taking a sip of liquid or a bite of food is interrupted on a persistent basis?
The ability to swallow easily and safely is impaired and can now be defined as “dysphagia”.
What is dysphagia?
Dysphagia is a condition that causes an individual to experience difficulty when swallowing. There are many causes of dysphagia and symptoms can vary greatly among individuals. Symptoms of dysphagia may range from very mild to very severe. Individuals who experience difficulty swallowing may have difficulty swallowing liquids, certain types of foods, or even their own saliva. In very severe cases, dysphagia can result in a complete inability to swallow.
Difficulties with swallowing will not only impact on the ability to maintain adequate nutrition and hydration, but, can have a major impact on overall quality of life.
Dysphagia can affect individuals of all ages; ranging in age from infant to geriatric.
According to The National Foundation of Swallowing Disorders, epidemiologic studies indicate that the numbers of individuals with dysphagia may be as high as 22% of the population over the age of 50 years old.
What are the symptoms of dysphagia?
According to the American Speech-Language-Hearing Association, adults with dysphagia may present with the following signs and symptoms. Again, these signs and symptoms will vary among individuals:
• Coughing during or right after eating or drinking
• Wet or gurgly sounding voice during or after eating or drinking
• Extra effort or time needed to chew or swallow
• Food or liquid spillage from the mouth or getting stuck in the mouth
• Recurring pneumonia or chest congestion after eating
• Weight loss or dehydration from not being able to eat or drink enough
Dysphagia can put the adult individual at risk for one or more of the following:
• Inadequate nutrition
• Aspiration pneumonia resulting from food or liquid entering the lungs
• Social isolation resulting from restriction of eating a variety of foods which
leads to avoidance of participation in social activities
• Fear of eating
• Emotional disturbance such as depression
What causes dysphagia?
Dysphagia itself is not a disease. Dysphagia is disorder that presents as the result of an underlying cause.
Causes of dysphagia in adults may be due to:
Aging – muscles of the mouth, throat and esophagus become weak as
an individual ages resulting in an inability to move food and liquid from the
oral cavity back to the throat, into the esophagus and finally into the stomach
Infections or irritations that obstruct or cause narrowing of the esophagus. For example, ulcers and
Neurological conditions which affect muscle strength and coordination of the structures involved
in eating and drinking. Some of the causes may be cerebral vascular accidents (stroke),
Parkinson’s Disease, Multiple Sclerosis, Amyotropic lateral sclerosis (ALS or Lou Gerhig’s
Disease), Muscular Dystrophy, Alzheimer’s Disease, traumatic brain injury, and brain tumors.
Head and neck cancer
Individuals who have been diagnosed with dysphagia will most likely require diet modification. Modification of diet will be made based on severity of the swallowing difficulties that the individual is experiencing, and according to their risk for aspiration.
Following the completion and interpretation of a series of diagnostic assessments, it is the job of the speech-language pathologist to determine the level of diet modification that will provide safe and nutritious food consistencies for an individual experiencing dysphagia.
The National Dysphagia Diet (NDD) is the national standard for the treatment of dysphagia. Speech pathologists with expertise in treating individuals with dysphagia adhere to these guidelines when recommending a modified dysphagia diet. The four (4) levels included in the National Dysphagia Diet are as follows:
NDD Level 1 – Dysphagia Pureed (all foods are pureed to a pudding consistency and lump free where very little or no chewing is necessary)
NDD Level 2 – Dysphagia Mechanically Altered (all foods are moist, soft-textured and easily chewed)
NDD Level 3 – Dysphagia Advanced (includes most foods with the exception of hard, dry, sticky or crunchy foods. Food should be moist and in bite-size)
NDD Level 4 - Regular (no restrictions)
Individuals diagnosed with dysphagia experience changes in diet, as well as changes in lifestyle. The act of eating is not only for nutritional purposes, but plays an important role in many aspects of a person’s life. Social gatherings for special events such as birthdays, weddings and holidays are usually centered around delicious meals. Individuals with dysphagia will often avoid social gatherings because they are limited in what they can now eat. This restriction may ultimately impact on the individual’s emotional and social well- being and cause avoidance of participation in many social activities and events.
The team at Textured Food Innovations recognized that people with dysphagia deserve food that is visually appealing and tastes delicious even though their diet now requires modification. Therefore, we have developed a menu of pureed meals that look and taste fantastic. Our culinary trained chefs use the same ingredients that are included in regular food. They then uniquely modify it to a pureed consistency while maintaining the look of regular food. We even offer a line of pureed desserts that are both appealing to the eye and taste scrumptious.
Our talented team will be happy to create a menu which includes a variety of pureed meals just for you.
So give us a call at (844) TEXFOOD and start enjoying your food once again