The relationship between speaking and swallowing

In honor of National Dysphagia Awareness Month, we want to take a moment to focus on the health care professionals that treat patients with dysphagia and who do so much to improve their quality of life. The surprising part is that you may never guess the job description from the title: Speech-Language Pathologists (SLPs) are the professionals who most commonly treat swallowing problems.

What does language have to do with swallowing?

As the title suggests, Speech-Language Pathologists assess, diagnose, and help treat communication disorders such as complete lack of voice, fluency disruptions (like stuttering), and even people who have voice disorders such as a very harsh pitch. So, why do they see patients who have difficulty swallowing as well?

The same physical mouth structures that are involved in speaking are also involved in swallowing. More than that, when infants first learn sucking and swallowing motions with the tongue, these movements form the basis for sound production for when they begin speaking.

The top of the tongue is crucial for producing sounds. The placement of the tongue in the mouth enables humans to pronounce different phonemes, or perpetually distinct units of sound that differentiate one word from another in a given language. Example:

  • The consonant “t” as in “top” is pronounced as the tongue contacts the alveolar region of the mouth, the bony ridge behind the teeth.
  • The consonant “k” as in “cop” is produced when the tongue contacts the velar region, the soft palate near the back of the roof of the mouth.

The swallowing process involves similar tongue motions to speech production. The oral preparatory phase of swallowing frequently involves some lateral tongue movement as the mouth positions the bolus (solid or liquid) to be swallowed. Then, during the oral phase, the tongue moves upwards and backwards against hard and soft palates to push the bolus towards the throat. You can see an animation of this movement in the video below:

https://www.youtube.com/watch?v=wqMCzuIiPaM

It is common for children who are diagnosed with speech impediments to also have swallowing difficulties.

How do speech-language pathologists treat swallowing disorders?

The treatment methods an SLP employs for swallowing disorders vary depending on the specific condition. Some examples:

  • Perform video fluoroscopic swallow studies to identify how food moves through the mouth and throat.
  • Assess whether patients are ready to eat orally after having been fed with a feeding tube, which can be done by asking patients to perform activities like clearing their throats and watching how they manage saliva.
  • Teach swallowing exercises to patients who need to regain swallowing ability, such as trauma victims and chemo patients.
  • Create diets based on food textures that align with the patient’s ability to take them in. Textures of a dysphagia diet can include pureed solids, thin liquids, nectar-thick liquids and more depending on the SLP’s plan.

In addition to the above, SLP’s have an important role in improving the quality of life for patients, since eating is an activity deeply associated with pleasure, fun, socialization, and cultural significance. Brenda Arend critical care SLP and guest blogger on “Tactus Therapy,” shares a touching story of her visiting a patient who is in the last stages of life:

Fortunately, the patient’s daughter is in the room with him, and she expresses that she wants him to be able to eat and drink a little. After doing a brief bedside swallow evaluation, I explain the terms “comfort feeding” (just for pleasure, not nutrition) and “aspiration” (food or liquid entering the lungs), and we talk for a while to figure out what the right balance of risk and benefit will be for her dad. Basically, we want to find the least unsafe diet for him that still satisfies his desire to eat. We land on a pureed diet and sips of thin liquid, allowing him to have a few bites when he is alert enough to swallow. He is awake enough to agree and thanks me for the spoonfuls of ice cream I gave him earlier.

The next day I found out he passed away in the night, so those ice cream bites were the last food he ever ate. This makes me sad, but also grateful I was able to help.”

At-home products for swallowing disorders

Bionix deeply admires the work SLPs do and are proud we get to create products that can assist their patients to feed orally. The SafeStraw™ Drinking Aid for Thin Liquid and the SafeStraw™ Drinking Aid for Thick Liquid limit the volume that the user can accept in one sip, reducing the risk of aspiration. SLPs across the country have used and recommended them, and we hope they can bring a bright spot into a patient’s life.

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