Whether the person with the swallowing difficulty has an acquired or progressive neurological condition, understanding the aetiology will allow the speech and language therapist assessing the swallow to have a better understanding of the likely implications for future swallow management e.g. is it degenerative, will there be surgery involved, what effect will medications have. It is most likely that a person with a swallowing difficulty will be assessed on more than one occasion and the swallow function may change over time. Using quantitative methods of examination can provide a more objective method of monitoring these changes; for example, peak cough airflow or induced cough testing, and can be more reliable than self-reporting when people with conditions such as Parkinson’s disease may experience reduced sensory feedback and may not be aware of silent aspiration. The main aims in swallow management are the maintenance of safe hydration and nutrition and maximising quality of life. Compensatory manoeuvres and diet modifications may be a priority but, equally, management of salivation or conversations about future non-oral feeding options in order to facilitate informed decision making may be equally important. In conditions such as motor neurone disease, placement of a feeding tube may be dependent on the individual’s respiratory status. For those with language and cognitive difficulties, many aspects of swallow management may fall to their friends and family. This article emphasises the need to consider the assessment and management of swallow disorders on an individual basis, thus reinforcing the person-centred approach that is central to management of progressive neurological conditions in the UK.
Swallow this: management of dysphagia in progressive neurological conditions
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