Swallowing Treatment at Wake Forest Baptist
Difficulty swallowing, or dysphagia, can impact your quality of life. We
specialize in treating patients who have problems swallowing foods, liquids,
medications, or even saliva. Our speech-language pathologists use the latest
exams and technology to assess swallowing and aspiration, or the entry of food
and liquid into the airway, and then develop an individualized treatment plan
for each patient.
On this page, you can learn about our adult and inpatient rehab swallowing evaluations and treatment at WFBH. Click here to learn about the pediatric feeding and swallowing therapies available at our Brenner Children's Hospital and Medical Plaza Miller.
Wake Forest Baptist speech-language pathologists may use one or more
of the following tests to examine a patient’s muscles and see how foods and
liquids are swallowed.
Clinical Swallow Evaluation (CSE)
During a CSE, a non-invasive swallowing
evaluation, a speech-language pathologist looks at the movements of the mouth
and face and assesses breathing and secretion (saliva) management. Then, the
patient is given various food and liquids so that chewing and swallowing can be
observed. The speech-language pathologist will ask the patient and/or family
questions about eating habits and any observed eating difficulty.
Flexible Endoscopic Evaluation of Swallowing (FEES)
The FEES is a swallowing evaluation
where a small endoscope is gently passed through the nose to visualize the
throat from above, while swallowing. The patient is given various food and
liquids so that swallowing can be viewed in real time. Food and liquid is
typically dyed to allow for greater visualization.
Pharyngeal Function Study (PFS), also known as a Modified Barium Swallow
A PFS is an x-ray of the swallowing process performed in
conjunction with a radiologist. This involves a very low dose of radiation
exposure. The test is typically done for patients who have difficulty
swallowing liquids, solids or medications. The patient is given a variety of food and liquid
mixed with barium, a
contrast material that shows up on the x-ray when you swallow.
Comprehensive Swallowing Therapy
offer a variety of swallowing therapies to help strengthen swallow muscles and improve
swallow function and safety. These treatments are customized for each patient
and may include:
Oral and Pharyngeal Strengthening Exercises
These exercises focus on improving strength,
timing and coordination of the muscles of the mouth, tongue and throat.
Surface Electromyography (sEMG)
Small electrodes are placed under the patient’s
chin to measure contraction of the swallowing muscles and the data is
displayed on a computer or handheld monitor in real time. This provides visual biofeedback
that helps the patient improve swallowing effort.
Lingual manometry is used to evaluate
and improve tongue strength. Small air-filled bulbs are placed on the tongue.
The patient then presses the bulbs against the roof of the mouth while a
computer or handheld screen monitors the activity. This provides visual biofeedback during
tongue strengthening exercises.
An endoscope is placed through the nose
to allow visualization of the throat. The patient is able to practice
swallowing exercises, maneuvers and strategies. This allows for increased
awareness of targeted outcomes.
Small electrodes are placed on the face or under the chin and
deliver an electrical current to stimulate the muscles in that area. This is performed together with traditional swallowing exercises..
Cold and/or flavored foods (such as lemon
flavored swabs, ice chips or popsicles) are given to the patient in effort to
create a swallow response. The use of the cold or flavor may help a patient who
has decreased sensation, or feeling of foods and liquids, to notice the
foods/liquids and swallow them in a more timely fashion. In such patients, speeding up the response
time increases their safety. This is performed with traditional swallowing
Respiratory Training and Biofeedback
Respiratory training can be provided to improve breathing methods, improving strength for breathing in and out. This improves swallowing, reduces congestion, and helps clear airways. The patient is taught to use a handheld device to work on better breathing in and out. In addition, biofeedback can be utilized to increase attention to respiration during the swallow. The patient wears a nasal cannula to measure inspiration and exhalation during swallowing, which is captured in conjunction with sEMG. This
allows for visual biofeedback of the respiratory pattern to improve the
coordination of respiration and swallowing.
trained speech-language pathologists can provide gentle and sustained
stretching to release muscle restriction and improve range of motion. This
eases pain and aids in improved swallowing function.
We use the
TheraBite® Jaw Motion Rehabilitation System™ to help patients who have problems
with the jaw, like difficulty biting, chewing, speaking and swallowing. We help
develop a therapy plan and educate patients about use of the device.
We also offer caregiver education regarding diet and swallowing.
therapy takes time and requires your commitment and dedication. We offer both
inpatient and outpatient care. We work closely with inpatients during their
hospital stay and encourage swallowing therapy two to three times per week for
12 to 16 weeks for outpatients. A self-led and/or home exercise program is also
strongly recommended to improve results. We continue to work closely with you
after your initial treatment, providing suggestions for follow-up care and
evaluating your progress.