Pathophysiology, Evaluation and Treatment of Swallowing Disorders

This chapter will cover basic swallow physiology, outlining the phases of swallowing (oral, pharyngeal, esophageal) and the neural correlates. The aging swallow will be addressed, as well as diagnoses (illness and injury) commonly associated with dysphagia. The author will elucidate evidence-based techniques related to instrumental and clinical assessment of swallow functionality and safety. Moreover, the author will review therapeutic best practices for the rehabilitation of swallow function when dysphagia (difficulty swallowing) has been diagnosed. Dysphagia considerations in restorative and palliative care contexts will be described in detail, including recent research on patient outcomes based on feeding route (oral vs. tube) at the end of life. Compensatory strategies and behavioral strategies designed to lessen the negative physiological and psychological impacts of dysphagia will be covered. The International Dysphagia Diet Standardization Initiative (IDDSI) and its impact on dysphagia risk reduction will be explained.