• "50-75% of Nursing Home residents have swallowing difficulties"
• "35% of people aged 50-79 complain of swallowing difficulty"
• "45% of people over the age of 75 suffer symptoms of dysphagia" ie difficulty swallowing
• "Over 50% of people with Parkinson’s Disease have difficulty swallowing"
• "76% of people with MND have impaired swallowing"
• "Approximately 45% of people with Multiple Sclerosis have swallowing difficulty"
  

Swallowing is the act of moving food or fluids from the mouth to the stomach. It involves a complex sequence of movements and requires precise muscle control.

There are 3 stages of swallowing.

Oral Phase Involves chewing/manipulation of food or dirnk and moving it to the back of the mouth to be swallowed.    Pharyngeal Phase Food and fluid move through the throat and into the oesophagus. Breathing stops for about 1 second.   Oesophageal Phase The passing of the food or fluid through the oesophagus and into the stomach

• Dysphagia - Difficulty swallowing during any of the 3 stages of swallowing.
  
• Aspiration - Food, fluid, saliva or stomach contents entering the lungs. Aspiration may result in pneumonia.
  
• Bolus - The food or fluid to be swallowed

• Coughing or choking during or after eating or drinking
• Wet or gurgly sounding voice during or after eating or drinking
• Unusually slow eating or drinking
• Fatigue or shortness of breath while eating or drinking
• Food or liquid leaking from the mouth or getting stuck in the mouth
• Weight loss or dehydration from not being able to eat or drink enough
• Drooling
• Recurrent chest infections or pneumonia

Swallowing difficulties may result in :-

Speech Pathologists are involved in the assessment and diagnosis of the type, nature and severity of the swallowing disorder. This may involve;

Taking a careful history of medical conditions and symptoms Looking at the strength and movement of muscles involved in chewing and swallowing Observing posture, behaviour and oral movements during eating or drinking Clinical assessment using a variety of food and fluid consistencies Use of cervical auscultation to listen to swallowing sounds and breathing to aid with clinical assessment (see picture) Performing objective tests to evaluate swallowing (Modified Barium Swallow/Nasendoscopic evaluation)

May include:

Posture changes - eg; head rotation Maneuvers/techniques - to increase the safety of the swallow and airway protection Modifying eating/drinking environment - eg. increasing eating independence with modified cutlery Therapy exercises - to improve muscle movements needed for chewing and swallowing Modifying diet/fluids - changes with regards to texture of food and thickness of fluids Objective assessment of swallowing - including modified barium swallow, nasendoscopic evaluation of swallow function or pharyngeal manometry Alternative feeding options - such as percutaneous endoscopic gastrostomy (PEG), a tube that goes directly into the stomach for nutrition and hydration

The RGH Speech Pathology Department offers people with swallowing disorders a comprehensive service to:

Inpatients -

• In the acute and rehabilitation wards and in Daw House Hospice
• In patients’ homes if part of the Rehabilitation in the Home (RITHOM) program
  

Outpatients -

• In the Swallowing Disorders Clinic
• In the Speech Pathology Department

The Speech Pathology component of the MS Clinic provides a unique assessment and management service for outpatients with communication and/or swallowing impairments as a result of Multiple Sclerosis (or similar illness). The clinic established by the MS Society incorporates the services of a multi-disciplinary team.

This service is available to any member of the MS Society who is referred by their GP.
Please contact the MS Society on 8360 0800 for more details about the clinic.

RITHOM is a home-based rehabilitation program offered to appropriate patients following an admission to hospital. Restrictions do apply with regards to length of hospital stay prior to being accepted by the program and length of program after discharge. Please contact the hospital on 8276 9666 for further details.

Outpatients - The Speech Pathology Outpatient Department at RGH is located at Reception A in the Rehabilitation and Therapy Services Building on the northern side of the hospital campus.

Inpatients - Hospital inpatients are seen in the acute wards or in the Speech Pathology department if required. Inpatients of the rehabilitation ward are seen in the speech pathology treatment offices on the ward.

Swallowing Disorders Clinic - This clinic is located in The Repat Clinics, Clinic B on the South West corner of the hospital campus. Procedures (Modified Barium Swallow Examinations, Nasendoscopic Evaluation of Swallow Function, Manometry) are performed in Radiology/X-Ray or Investigative Procedures Unit (IPU). All patients attending this clinic for a procedure must report to IPU reception.

Inpatients - Referrals can be made directly to the Speech Pathologist allocated to each ward via pager or in person. If the allocated person is not available then referrals can be made by phoning the Speech Pathology Department on Ext 1787 between 8am and 3pm on Monday - Friday. A doctor's referral is required for people who are suspected of having swallowing difficulties.

Outpatients - Referrals relating to swallowing disorders are managed through the Swallowing Disorders Clinic. A medical referral is required, please address to the Swallowing Disorders Clinic.

The minimum requirement for working as a speech pathologist is a 4 year university course in Bachelor of Speech Pathology. For 2004, a Tertiary Entrance Rank of  95.05 was required to be accepted into the degree program at Flinders University of South Australia.