Dysphagia in Adults

At Expressable, we help people with swallowing disorders improve their ability to consume a variety of foods and liquids as safely as possible. Our dysphagia program teaches evidence-based strategies for swallowing function and safety, with caregiver education and home exercises so you can make faster progress.

Dysphagia is a swallowing disorder that affects the way a person eats and drinks. It must be treated quickly in order to ensure the person can eat safely and get adequate nutrition. Dysphagia can be caused by a stroke, traumatic brain injury (TBI), spinal cord injury, head and neck cancer, multiple sclerosis (MS), Lou Gehrig's disease (ALS), dementia, Parkinson's disease, and other neurological diseases. Swallowing problems can also be associated with pulmonary diseases, acid reflux, muscle weakness, and medication side effects.

Some signs of swallowing problems may include: 

• Drooling and/or difficulty managing food and liquids 

• Extra time and effort needed to chew and swallow 

• Feeling like food is stuck in the throat (known as globus sensation)

• Gurgly voice, coughing, or choking during or after eating and drinking 

• Difficulty coordinating breathing and swallowing 

• Recurrent pneumonia (due to food or liquid entering the airway)

This article explains Expressable’s clinical approach to treating swallowing disorders. You can also view our complete guide to adult dysphagia to learn more about this diagnosis.

1Why is therapy for dysphagia important?

2How Expressable treats swallowing disorders in adults

3Practice swallowing strategies at home with the Expressable portal

4The benefits of online swallowing therapy

5Get matched with a feeding therapist today

Why is therapy for dysphagia important?

Safely eating and drinking is essential for good health and nutrition. Many people with dysphagia are at risk of aspiration, which is when food or liquid enters the airway. Complications such as pneumonia or even choking can occur. This is why it’s so important for people with swallowing problems to see a therapist as soon as possible. 

Feeding and swallowing therapy falls into the scope of practice for speech-language pathologists, also known as speech therapists. (You may also hear your therapist referred to as a feeding therapist.) Speech therapists play an essential role in assessing, treating, and managing swallowing disorders. They work along with other healthcare providers, like head and neck surgeons (ENTs), gastroenterologists (GI doctors), and even physical therapists, to assist with proper positioning when eating. 

Speech therapists play an essential role in assessing, treating, and managing swallowing disorders.

The more quickly a person begins swallowing therapy, the sooner they will improve their swallow function. Therapy may involve modifications (changes) to the person’s diet and a variety of exercises and techniques to achieve a safer swallow. While each person’s treatment plan will be tailored to their needs and goals, the Expressable dysphagia program generally focuses on:

• Improving quality of life by increasing the ability to eat and drink as safely as possible

• Using evidence-based exercises and techniques to improve swallow function 

• Educating clients and families to build confidence with swallowing strategies and ensure caregivers understand feeding safety 

How Expressable treats swallowing disorders in adults 

Expressable provides online feeding and swallowing therapy. It’s important to know that some types of feeding therapy can be done online, but not all. Some people who can’t safely eat by mouth may need in-person feeding therapy. The speech therapist may need to be physically present to observe the person’s swallowing abilities and how they handle food or liquid. This decision should be made by your doctor and speech therapist. 

Research has shown that online feeding therapy can work well for many people. Online swallowing therapy is convenient, offers wider access to speech therapists, and makes it easier for family members to be involved.

Expressable matches people who are a good fit for teletherapy with a licensed speech therapist trained to evaluate and treat dysphagia. All therapy is delivered online via face-to-face video conferencing on Zoom.

A caregiver or support person must be present during sessions for safety and support. In fact, educating loved ones is one of the most important parts of swallowing therapy.

A caregiver or support person must be present during sessions for safety and support. They can help prepare any foods and liquids to be used during sessions, and they can help ensure the person is positioned and equipped correctly.

In fact, educating loved ones is one of the most important parts of swallowing therapy. Caregivers and family members eat with the patient most often, so it’s important to understand the techniques and approaches used in therapy.

At Expressable, caregiver coaching is a key part of our dysphagia treatment program. We provide comprehensive guidance on safety precautions, recognizing signs of feeding distress, and how to support your loved one during meals. Online sessions make it easy for caregivers to attend, so you can learn these strategies directly from the therapist and confidently practice them at home. 

Expressable’s clinical approach to evaluating dysphagia

Swallowing therapy will begin with an evaluation. Your speech therapist will choose from a variety of questionnaires and checklists, such as the Eating Assessment Tool (EAT-10) and the Feeding Impact Scale. 

Your feeding therapist will also use functional measures, such as clinical observation, to holistically assess your current feeding abilities. If online feeding therapy is determined to be safe and appropriate for you, the therapist will likely want to watch you eat and drink.

Your speech therapist will likely do the following during the dysphagia evaluation:

• Review your medical history

• Examine the anatomy of your mouth, as well as your oral-motor skills and mouth movements

• Observe any potential signs of aspiration 

• Observe how you handle different textures of food and liquid 

If the therapist thinks a diagnostic swallow study is necessary, they will request a referral for this test. Diagnostic tests with imaging allow speech therapists to evaluate the anatomy and physiology of the structures used for swallowing in order to determine if dysphagia is present, along with its severity and possible causes. Two diagnostic tests can be done to determine if the person is aspirating on food or liquid and what diet may be safest for them:

• Videofluoroscopic Swallowing Study (VFSS) – Involves X-ray imaging

• Flexible Endoscopic Evaluation of Swallowing (FEES) – Involves a nasal endoscope with a tiny camera at the end

If dysphagia treatment is recommended, the evaluation results will be used to develop a personalized care plan. Treatment for feeding problems typically includes two therapy sessions per week.

Evidence-based strategies for treating swallowing disorders

If you are approved to start online feeding therapy, therapy will focus on finding foods and liquids you can safely eat and drink to minimize your risk of choking or aspiration. Your speech therapist will also assess whether you can safely eat and drink by mouth. If not, an alternative means of nutrition may be considered, such as a g-tube. 

Your speech therapist may teach you exercises to increase your strength and coordination to improve your ability to eat. As an example, some people may have poor tongue control or movement, which makes it hard to move food around safely in their mouth. The muscles in their neck used for swallowing may also be weak, which raises the risk for aspiration or choking. Strengthening the muscles used for eating and drinking can help people eat and drink more safely.

Swallowing therapy techniques may include: 

• Exercises to increase oral awareness and control

• Exercises for safer swallowing, such as the Mendelsohn maneuver or the supraglottic swallow maneuver

• A modified diet with textures that are safest for you to consume, such as pureed foods or thicker or thinner liquids

• Specific postures or positioning when eating and drinking, such as the chin tuck or head tilt postures

• Learning how to identify signs of swallowing problems and aspiration for safer mealtimes

You can learn more about what to expect in dysphagia treatment in our expert guide to swallowing disorders.

Practice swallowing strategies at home with the Expressable portal

At Expressable, feeding therapy doesn’t stop when your session ends. You’ll have ongoing text messaging support so you can ask questions or get tips from your speech therapist between sessions. You’ll also have access to our client portal, which makes it easier to practice eating and swallowing skills throughout the week. The more often you practice, the faster you’ll make progress!

In the portal, you’ll find Learning Paths that explain and reinforce the strategies you’re using in sessions, such as specific chewing skills or the Shaker exercise:

You can watch videos that show real feeding techniques, such as the effortful swallow exercise:

Your speech therapist will assign personalized practice activities you can use during meals, such as sensory strategies for improved oral awareness:

The benefits of online swallowing therapy 

When teletherapy is an option for swallowing problems, there are many reasons people prefer it:

1 Wider access to qualified feeding therapists

With online swallowing therapy, it’s not hard to find a speech therapist who’s experienced in treating swallowing disorders. You have access to an entire network of feeding therapists who are licensed to treat in your state. This is especially beneficial for people who live in rural places or in areas with waitlists for therapy.

2 Convenience and flexibility

Between work, errands, and family responsibilities, it can be hard to regularly attend in-person therapy sessions. Not only is there the commute time, but most speech therapy clinics are only open during normal business hours. For many people and their caregivers or loved ones, that just isn’t convenient.

Online feeding therapy removes this problem. At Expressable, you can schedule sessions on the days that work best, at the times that are most convenient, including evenings and weekends. 

Doing feeding therapy from the comfort and familiarity of home can put you at ease. And when you feel comfortable, therapy will be more effective.

3 Swallowing therapy in the comfort of home

If you’re feeling nervous about swallowing therapy, you’re not alone. Working through eating challenges can be stressful for those with dysphagia. Doing feeding therapy from the comfort and familiarity of home can put you at ease. And when you feel comfortable, therapy will be more effective.

Another benefit of online therapy is that caregivers can easily attend and learn safe swallowing techniques. As explained earlier, caregiver education and support is a key part of treatment for swallowing disorders. 

4 Cost and affordability

In-person speech therapy clinics have many expenses that aren’t directly related to your care, such as rent, utilities, and other operational costs. As with any business, these costs are often passed down to the consumer.

The cost of speech therapy will vary by provider, but generally, the cost of online feeding therapy will be less than an in-person practice—even though you receive the same quality of treatment.

Get matched with a feeding therapist today

Expressable speech therapists consistently earn ratings of 4.9 out of 5 stars from their clients. Here’s just one example of a client review:

“[My therapist] Ms. Johnson is kind and patient, as well as very professional. I'm extremely pleased with our sessions so far and quite confident my speech and swallowing concerns will be fully restored.” 

Feeding therapy can help you improve your swallow and safely consume more foods and liquids. We’re here to support you every step of the way. Click here to get matched with a feeding therapist.