Dysphagia Management Strategies
Following identification of dysphagia, an interdisciplinary team approach is best practice to determine appropriate management strategies. The goal of dysphagia intervention is to facilitate oral intake while minimizing risk of airway compromise. The broad range of etiologies resulting in dysphagia create a heterogenous population and as a result, management is typically individualized to target specific skills or swallowing pathophysiology. Medical, surgical, skill, and nutrition considerations contribute to optimal management.
Optimal management can include:
- compensation (strategies which aim to immediately improve safety by compensating for pathophysiology)
- rehabilitation (interventions which aim to improve skills by influencing the physiologic underpinnings of the oropharyngeal mechanism)
- habilitation (interventions which aim to attain or keep skills)
- a combination of these (Speech Pathology Australia, 2012); (Khamis, et al., 2020)
Best available evidence suggests that individualized rehabilitation interventions should be based on oral and pharyngeal physiology. When interventions are aligned with motor learning principles combined with compensatory strategies, they can improve oral feedings skills and reduce reliance on tube-feeding (Khamis, et al., 2020).
Regular monitoring and re-evaluation by the interdisciplinary team is crucial to ensuring that pulmonary health is monitored where a dysfunctional swallow is suspected or established. Other roles of the team are to ensure that there is not reliance on compensatory strategies longer than clinically required (Khamis, et al., 2020), and the child continues to have a safe route for nutrition and hydration. Non-oral feeding should be considered when all other oral management options have been exhausted. Non-oral feeding may be provided in combination with oral feeds (Adams, Elias, & Council on Children with Disabilities, 2014).
If there is evidence of swallow dysfunction from an instrumental swallowing study, any changes to the viscosity or texture of fluids or solids must be closely supervised by the physician and dysphagia practitioner with ongoing re-evaluation.
Table 1 - Indicators that Child is at Risk or may be Aspirating
Table 6 - Signs of Swallowing Safety Concern in Infants and Management Strategies
PEAS Role Descriptors and Tasks within Full Scope