Swallowing Disorders (Dysphagia) Therapy at Home

What a swallowing disorder is

Everyone has the occasional drink that goes down the wrong way. A person with a swallowing disorder has trouble like that much of the time. Swallowing is a complex, coordinated action of muscles and nerves that happens in three phases, and a problem can occur in one or more of them.

When the airway does not close off properly, food or liquid can enter it. This is called aspiration, and it can cause coughing and choking, or lung infections.

Causes and risk factors

Swallowing problems often happen because of another condition. MedlinePlus, from the National Library of Medicine, lists these common causes:

Dysphagia can affect anyone, but it is more common in older adults. In people with neurological conditions, it often appears or worsens over time, so it is worth mentioning any change in eating or drinking to your physician.

Signs and complications

Signs of a swallowing problem

• Coughing during or right after eating or drinking
• Frequent throat clearing after eating or drinking
• A wet or gurgly voice during or after eating or drinking
• A feeling that something is stuck in the throat or chest
• Needing extra effort or time to chew or swallow, or food getting stuck in the mouth
• Food or liquid leaking from the mouth
• Difficulty breathing after meals, or weight loss

Possible complications

• Dehydration or poor nutrition
• Aspiration pneumonia and other lung infections, when food or liquid goes into the airway
• Reflux
• Embarrassment at mealtimes, and avoiding eating with others

When to get help

• Tell your physician about coughing or choking with meals, a wet voice after swallowing, unplanned weight loss, repeated chest infections, or pain with swallowing.
• Ask for a swallowing evaluation by a speech-language pathologist who works with adults. Your physician can refer you.
• Do not change food textures or stop eating on your own without guidance, because some changes can create new risks or malnutrition.
• Report new swallowing trouble after a stroke or head injury right away.

How it affects daily life

How swallowing is evaluated

A speech-language pathologist (SLP) will ask about your health, past illnesses, surgeries and swallowing problems, check how well your mouth muscles move, and watch you eat and drink to see your posture, how you feed yourself, and what happens when you swallow. If more detail is needed, special tests may be ordered through your physician:

• Modified barium swallow: you eat or drink food or liquid containing barium, which shows up on an X-ray so the clinician can watch where it goes.
• Endoscopic assessment: a thin tube with a light and camera is passed through the nose to watch the swallow on a screen.

These tests are done at a hospital or clinic. An in-home evaluation can screen for problems, guide safe strategies and help decide whether further testing is needed.

How care works

The treatment you need depends on the problem. You may need medical care from a physician, for example medicine for reflux. In some cases nutrition is supplemented in other ways, such as a feeding tube, which your doctor will discuss with you. The SLP works with you to improve how you swallow.

Treatment may include exercises that strengthen the muscles used for chewing and swallowing, instruction on how to sit or hold your head when you eat, strategies that make swallowing safer, and eating softer foods or drinking thicker drinks to make swallowing easier. Family and caregivers can help by following the SLP’s suggestions, helping with exercises, providing food and drink that can be swallowed safely, and keeping track of how much is eaten and drunk.

What speech and occupational therapy each do

Speech-language pathology: evaluating and retraining the swallow

• Evaluation of oral, throat and swallowing function, including watching you eat and drink
• Exercises to strengthen and coordinate the muscles for chewing and swallowing
• Posture and head-position strategies, and safer ways to take bites and sips
• Recommendations for food and liquid textures that are safer for you, coordinated with your physician and dietitian
• Referral for instrumental testing such as a barium swallow when needed
• Training for family and caregivers, including warning signs to watch for

Occupational therapy: making mealtimes safer and easier

• Positioning at the table or in bed for safer swallowing
• Adaptive utensils, cups and plates for tremor, weakness or limited hand function
• Self-feeding training and strategies for fatigue
• Setting up the eating environment to reduce distractions
• Support for hand and arm function that affects eating

Supporting services

What an ELEVATE home visit looks like

• Review: your history, medicines, how eating and drinking have changed, and your doctors’ recommendations.
• Assessment: oral and throat function, a look at how you eat and drink, and posture and feeding skills.
• Mealtime setup: seating, utensils, kitchen and eating environment.
• Plan: exercises, safe-eating strategies and goals, plus training for family and caregivers.
• Communication: progress shared with your physician, with referral for further testing if needed.

ELEVATE serves adults in Oakland and Macomb County, Michigan, with licensed speech-language, occupational and physical therapists. See Payments & Insurance for details.

Questions families ask

Trusted resources for swallowing disorders

These organizations are the leading sources of education and support for this condition. We are not affiliated with them.

Related guides

Browse every condition we treat on our Conditions We Treat page.

Sources and medical note

• Communication Health Support Association: Swallowing Disorders in Adults (patient information from the speech-language pathology profession).
• National Library of Medicine, MedlinePlus: Swallowing Disorders.

This page is educational and is not medical advice. It does not replace your physician’s care. Always follow your physician’s and speech-language pathologist’s instructions. If someone is choking and cannot breathe, cough or speak, call 911 immediately.