By Evangelia – Eugenia Tsaprali
Speech Therapist (BSc)
ANAPLASI Medical Rehabilitation Center
World Speech Therapy Day, celebrated every year on March 6, is an important opportunity to inform and raise public awareness about speech and swallowing disorders.
Swallowing is a complex sensory-motor process that involves voluntary and automatic movements, which requires the coordinated contraction and relaxation of 50 pairs of muscle groups and the participation of cranial nerves. Swallowing disorders, also known as dysphagia, can significantly affect a person’s quality of life, increasing the risk of choking, aspiration, and pneumonia from aspirating food or liquids.
The diagnosis and treatment of dysphagia often requires a multidimensional approach and collaboration between different specialties. In this context, the collaboration of otolaryngologists with speech therapists specialized in the treatment of feeding-swallowing disorders is crucial for the effective treatment of dysphagia and the restoration of safe swallowing, using modern diagnostic tools, such as endoscopic evaluation. (or FEES – Fiberoptic Endoscopic Evaluation of Swallowing).
FEES is a safe, non-invasive, bloodless, painless and highly effective diagnostic method that allows the monitoring and evaluation of the swallowing process using an endoscope, which is inserted through the nose, after preparation of the nasal mucosa. After assessing the structures of the pharynx and larynx, a swallowing test is performed with foods of varying consistency depending on the patient’s symptoms (thin liquids – water, thick liquids, cream, solid foods), which are colored with a special dye. The examination is videotaped and the findings are recorded on a computer. During the examination, compensatory techniques can be performed by the speech therapist or the result of previous therapeutic interventions can be evaluated.
After the examination, the patient immediately returns to his daily life. At the completion of the examination, the Otolaryngologist will be able to discuss the results and design the appropriate treatment program for the patient, always in collaboration with the specialized speech therapist.
For approximately 30 years, ANAPLASI has had a Standard Dysphagia Unit for the evaluation and treatment of feeding-swallowing disorders. The ANAPLASI Dysphagia Team, coordinated by the Physiatrist, includes, in addition to important medical specialties (Otorhinolaryngologist, Pathologist, Neurologist, Pulmonologist, Radiologist, Gastroenterologist and Psychiatrist), both the Rehabilitation Nurse and the chief therapeutic specialties of Rehabilitation: Physiotherapist, Occupational Therapist, Speech Therapist, Clinical Nutritionist, Clinical Psychologist, Neuropsychologist.
In the Dysphagia Unit of ANAPLASIS, the FEES is used as a basic diagnostic tool for the evaluation and monitoring of feeding-swallowing disorders. The speech therapist, using the data of the endoscopic assessment, designs an individualized intervention program, depending on the patient’s needs, which includes:
- Change in posture.
- Strengthening the muscles involved in swallowing and improving their coordination.
- Compensatory swallowing techniques (e.g., labored swallowing, supraglottic swallowing).
- Changes in the texture of food or liquids through the use of a thickening agent.
In ANAPLASI, the role of nurses in particular, as well as therapeutic specialties (physiotherapists, occupational therapists, clinical nutritionists, clinical psychologists – neuropsychologists) is extremely important for the comprehensive care of patients with dysphagia. Each professional contributes to different aspects of swallowing rehabilitation, acting not only therapeutically, but also preventively, ensuring that patients will receive the right support to avoid complications and enhance their quality of life.
More specifically, the nurse plays an important role in the daily care of the patient and in the implementation of the instructions that arise before and after the endoscopic examination. In addition to monitoring the patient’s condition, the nurse is responsible for the correct positioning of the head or body during feeding. They also monitors compliance with dietary recommendations, ensuring that the patient follows appropriate modifications in food and fluid consumption, depending on their needs. In particular, nurses take care to monitor for signs of aspiration, in order to prevent complications such as aspiration pneumonia.
The physiotherapist also has an important role in the Rehabilitation of dysphagia, focusing on strengthening and Rehabilitation of the muscles of the pharynx and larynx, which are responsible for swallowing. Through specific exercises and techniques, the physiotherapist aims to improve the mobility of these muscles, in order to facilitate swallowing and prevent the risk of aspiration. The physiotherapist can implement strategies that involve enhancing the mobility of the neck and head, helping the patient find the most appropriate position for safe swallowing. Physiotherapists also help with breathing exercises to protect the airways during swallowing, thus reducing the risk of food aspiration into the lungs.
The occupational therapist plays an important role in the management and recovery of patients with dysphagia. He assesses the patient’s physical condition, including strength, mobility and coordinated movement of the muscles involved in swallowing. He develops an individualized treatment program based on the patient’s needs and capabilities. He uses techniques, such as head tilt or head rotation, to minimize the risk of aspiration. Occupational therapy in dysphagia is a multidimensional process that requires specialized knowledge and skills. The occupational therapist contributes significantly to improving the quality of life of patients who experience swallowing difficulties.
The clinical nutritionists at ANAPLASI works closely with the speech therapist. They ensure that the patient receives optimum energy and nutrients during their hospitalization. They are responsible for modifying each patient’s diet in terms of its quantity and consistency, in order to avoid the risk of aspiration and to ensure the patient’s proper nutrition. In cases where food intake is limited, the nutritionist may recommend the use of supplements, such as proteins or vitamins, to meet nutritional needs and ensure the patient’s proper nutrition.
The role of the clinical psychologist and the neuropsychologist is particularly important for the comprehensive rehabilitation of patients suffering from dysphagia. Dysphagia can cause a significant psychological burden, such as feelings of hopelessness, social isolation, depression, anxiety or fear of swallowing, which can hinder the patient’s recovery from dysphagia. Psychologists formulate a psychological support program, which aims to emotionally empower and offer coping strategies, so that patients actively participate in their treatment. The role of the clinical psychologist is to help patients manage their emotions and adapt to the new reality.
In cases of neurological diseases, where dysphagia is affected by cognitive impairments, such as attention, memory, or executive function deficits, which may affect the patient’s ability to follow instructions for safe swallowing or to actively participate in therapeutic exercises. The Neuropsychologist assesses these functions to determine how they affect the patient’s ability to manage dysphagia. The role of the Neuropsychologist focuses on understanding cognitive needs using strategies, such as simplifying instructions, using visual aids, or implementing memory enhancement techniques. These strategies aim to improve the cognitive skills necessary for safe swallowing and management of dysphagia.
Speech therapists specializing in feeding and swallowing disorders, as members of the ANAPLASI Trans-Disciplinary Rehabilitation Team, remind us of the importance of caring for and supporting people suffering from dysphagia. Through diagnosis and appropriate treatment, we can improve the quality of life of these individuals and promote their health. It is therefore the duty of all of us to be informed and to raise awareness about these disorders, in order to help create a more supportive and understanding environment for people with dysphagia.
At ANAPLASI At ANAPLASI
“We do the maximum possible, not the minimum necessary.”
“We care for our patients as we would care for our own family.”
