Dysphagia, 36(2), 303315. British Medical Journal, 295(6595), 411414. Masako Maneuver: Stick your tongue out of your mouth between your front teeth and gently bite down to hold it in place. Patients may benefit from the use of adaptive equipment or environmental modifications to more effectively manage the bolus (Granell et al., 2012). identifying clinical presentations of dysphagia; identifying potential risks and benefits initiating or modifying oral intake (e.g., risks of dehydration/malnutrition); determining the need for additional instrumental evaluation; and. https://doi.org/10.1097/MCG.0000000000000624, Bahat, G., Yilmaz, O., Durmazoglu, S., Kilic, C., Tascioglu, C., & Karan, M. A. Education and counseling may be provided concerning issues related to tube feeding, such as appropriate positioning and duration of feeding times. SLPs may work with these patients and caregivers to develop compensatory strategies that will allow the patients to eat an oral diet for as long as they desire. ), Normal and abnormal swallowing (pp. Prevalence of subjective dysphagia in community residents aged over 87. It is best to do this exercise three to six times per day for at least six weeks. Clinicians modify bolus size particularly for patients that require a greater volume to adequately stimulate a swallow response (increase bolus size) or for patients that require multiple swallows per bolus (decrease bolus size). (2019). Visualize the structures of the upper aerodigestive tract. Dysphagia, 31(1), 4959. Do 5 reps 2 times per day. Lick three times and then do an effortful swallow with your lips firmly pressed together. Screening for dysphagia may be conducted by an SLP or any other member of the patients care team. We investigated the acute effects of effortful swallowing maneuver on HRV. (1989). Patient/care partners access to thickened liquids and/or thickening agents and ability to modify regular texture foods/liquids after discharge. Format refers to the structure of the assessment or treatment session, such as whether a person is seen for treatment one on one (i.e., individual), as part of a group during mealtime, or via telepractice. https://doi.org/10.1159/000112902, De Pauw, A., Dejaeger, E., DHooghe, B., & Carton, H. (2002). Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. https://doi.org/10.1001/archinte.159.17.2058. Screening identifies the need for further assessment and may be completed prior to a comprehensive evaluation. Board Certified Specialists in Swallowing and Swallowing Disorders are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with swallowing disorders. McGraw Hill. Improved Pharyngoesophageal Segment Opening. https://doi.org/10.1002/lary.26854, Brodsky, M. B., Huang, M., Shanholtz, C., Mendez-Tellez, P. A., Palmer, J. Cough response to aspiration in thin and thick fluids during FEES in hospitalized inpatients. (1999). Percutaneous endoscopic gastrostomy (PEG) tubes may not be appropriate in all populations and may not necessarily improve outcomes or quality of life (Ayman et al., 2016; Plonk, 2005). (2000). The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Additional assessment of voice, motor speech patterns, cognition, and communication, as warranted. See ASHAs Practice Portal page on. Archives of OtolaryngologyHead & Neck Surgery, 130(2), 208210. Conservative estimates suggest that dysphagia rates may be. You can either: Hold this position for 1 minute, and then lower your head and rest for 1 minute. High-resolution manometry: What about the pharynx? 2. Dysphagia in acute stroke. American Journal of Speech-Language Pathology, 25(4), 453469. https://doi.org/10.1177/0194599818815885. The Ampcare ES unit is a portable, non-invasive, dual-channel . Additionally, the effortful . The purpose of the technique is to compensate for deficits that cannot be or are not yet rehabilitated sufficiently. Dysphagia management often involves the implementation of compensatory strategies and/or rehabilitation exercises to optimise a person's swallow safety and efficiency (Easterling, Citation 2017).Voluntary pharyngeal swallowing manoeuvres are commonly used to alter pharyngeal physiology and bolus flow (Logemann, Citation 2008).The effortful swallow is frequently employed in . Administration of standardized screening protocols, such as, the 3-oz water swallow test (DePippo et al., 1992) and. https://doi.org/10.1007/PL00009517, Stone, D. B., Ward, E. C., Knijnik, S. R., Bogaardt, H., & Elliott, J. M. (2021). Archives of Physical Medicine and Rehabilitation, 74(7), 736739. The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22% (Aslam & Vaezi, 2013; Barczi et al., 2000), and in skilled nursing facilities, the prevalence rises to over 60% (Steele et al., 1997; Suiter & Gosa, 2019). Contraindications of Effortful Swallowing. radiation treatment protocols in head and neck cancer; psychosocial, environmental, and behavioral factors. Effortful swallowThe effortful swallow is known to increase orolingual pressure (Fukuoka et al., 2013) increase pressure in the upper pharynx (Huckabee & Steele, 2006) and to improve tongue base retraction. Chua, S., Dodd, H., Saeed, I. T., & Chakravarty, K. (2002). Dysphagia in stroke and neurologic disease. (2005) found that the incidence of dysphagia in stroke populations was as low as 37% when identified using cursory screening procedures and as high as 78% when identified using instrumental assessments. Aspiration pneumonia: A review of modern trends. SLPs have knowledge of the anatomy, physiology, and functional aspects of the upper aerodigestive tract as they relate to swallowing and speech. (2016). Kawashima, K., Motohashi, Y., & Fujishima, I. Oral-motor treatments range from passive to active (e.g., range-of-motion activities, resistance exercises, or chewing and swallowing exercises). Robbins, J., Gensler, G., Hind, J., Logemann, J. Internal and external evidence may come from. Swallow as hard as you can. https://doi.org/10.3810/hp.2010.02.276, Martin-Harris, B., Brodsky, M. B., Michel, Y., Ford, C. L., Walters, B., & Heffner, J. During any screening process, the members of the patient care team may note proper posture and positioning for eating, as well as any potential sensory deficits that may affect swallowing. Techniques and exercises: Maneuvers: Chin tug and turn. Other studies suggest that dysphagia occurs in 29%64% of stroke patients (Barer, 1989; Flowers et al., 2013; Gordon et al., 1987; Mann et al., 1999). The patient is severely agitated, unable to remain alert, or unable to follow simple commands. Dysphagia, 29(5), 603609. Relative contraindications for PEG are aspiration pneumonia due to gastroesophageal reflux, significant ascites, and morbid obesity. Although effortful swallowing would appear to be, at first inspection, a fairly benign intervention, a recognition of the delicate balance of biomechanical movements underlying swallowing suggests that there is the potential for unanticipated adverse outcomes. Repeat this up to 10 times in a single session. determining the effectiveness and possible impact of current diet on overall health (e.g., positioning, feeding dependency, environment, diet modification, compensations). A., Pauloski, B. R., Rademaker, A. W., & Colangelo, L. A. (2018). British Journal of Anaesthesia. In some cases, more viscous materials (i.e., thickened liquids) may be more likely to be silently aspirated (e.g., Miles et al., 2018). https://doi.org/10.1136/jnnp.52.2.236, Barikroo, A., Carnaby, G., & Crary, M. (2015). Effortful Swallow Position: Seated upright in a chair Repetitions: 10x Sets: 1x Frequency: 3x/day Steps: 1: Press your tongue firmly against the roof of your mouth 2: Squeeze the walls of your throat together forcefully and swallow hard *Tip: Pretend you are trying to swallow a hard-boiled egg. For example, the super-supraglottic swallow is a rehabilitative technique that increases closure at the entrance to the airway and may also serve as a compensation to protect the airway (McCabe et al., 2009). Biofeedback incorporates the patients ability to sense changes and aids in the treatment of feeding or swallowing disorders. (1999). (1991). Dysphagia in the elderly: Management and nutritional considerations. Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. Individuals of all ages are screened as needed, requested, or mandated or when presenting medical conditions (e.g., neurological or structural deficits) suggest that they are at risk for dysphagia. Archives of Physical Medicine and Rehabilitation, 82(12), 16611665. An example of a compensatory technique includes a head rotation, which is used during the swallow to direct the bolus toward one of the lateral channels of the pharyngeal cavity. American Speech-Language-Hearing Association Dosage primarily refers to the amount of treatment provided (e.g., the frequency, intensity, and duration of service). Dysphagia in multiple sclerosisPrevalence and prognostic factors. https://doi.org/10.1034/j.1600-0404.2002.10062.x, Calvo, I., Sunday, K. L., Macrae, P., & Humbert, I. The standards for ASHA certification effective in 2020 require competence in dysphagia. https://doi.org/10.1007/s00520-019-04920-z, Ra, J. Y., Hyun, J. K., Ko, K. R., & Lee, S. J. The patient is not medically stable enough to participate in the procedure. Cichero, J. A descriptive investigation of dysphagia in adults with intellectual disabilities. https://doi.org/10.1007/s00455-013-9471-z, Fukuoka, T., Ono, T., Hori, K., Tamine, K., Nozaki, S., Shimada, K., Yamamoto, N., Fukuda, Y., & Domen, K. (2013). Clinical Interventions in Aging, 7, 287298. https://doi.org/10.1016/j.apmr.2006.04.019, Humbert, I. Archives of Gerontology and Geriatrics, 56(1), 19. Effortful swallowing was also associated with significantly greater maximum velocities of the hyoid and larynx during swallowing. SLPs should consider how culture influences activities of daily living (Riquelme, 2004). cancer in the oral cavity, pharynx, nasopharynx, or esophagus; radiation and/or chemoradiation for head and neck cancer treatment; trauma or surgery involving the head and neck; critical care that may have included oral intubation and/or tracheostomy. (2001). identifying core team members and support services. Systematic review and meta-analysis of the association between sarcopenia and dysphagia. Members: 800-498-2071 After being educated about the risks and benefits of a particular recommendation (e.g., oral vs. non-oral means of nutrition, diet level, rehabilitative technique), if a patient (or their decision-maker) chooses an alternate course of action, the SLP makes recommendations and offers treatment as appropriate. The medical team may make temporary recommendations (e.g., no oral intake, stipulation of specific dietary precautions) while the patient is awaiting further assessment. masako, shaker, lingual isometric exercises, laryngeal elevation, oral motor exercises, base of tongue exercises . Dysphagia intervention may concentrate on swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education. Instrumental procedures are also used to determine appropriateness and effectiveness of treatment strategies. (n.d.). Dysphagia, 19(4), 266271. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 867888. Visualize the presence, location, and amount of secretions in the hypopharynx and larynx the patients sensitivity to the secretions; and the ability of spontaneous or facilitated efforts to clear the secretions. Oropharyngeal dysphagia after stroke: Incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. Instrumental techniques are usually conducted either independently by the SLP or by the SLP in conjunction with other members of the interprofessional team (e.g., radiologist, radiologic technologist, physiatrist, otolaryngologist). https://doi.org/10.1016/j.jcrc.2014.07.011, Doeltgen, S. H., Macrae, P., & Huckabee, M.-L. (2011). Intensive training can improve swallowing function and reduce the risk of aspiration. Current Opinion in Otolaryngology & Head and Neck Surgery, 26(6), 382391. Treatment targeting a specific function or structure may also affect function in other structures. https://doi.org/10.2147/CIA.S23404, Tabor, L. C., Plowman, E. K., Romero-Clark, C., & Youssof, S. (2018). Ongoing assessment can also include evaluation of changes in patients swallow function as a result of intervention, including diet modification, while implementing a plan of care. Plonk, W. M. (2005). A., & Lam, P. (2014). The Synchrony Dysphagia Solutions by ACP combines sEMG with a virtual environment to engage patients in fun, interactive swallowing and speech exercises. (2012). The patient has anatomical deviations (e.g., head/neck, digestive tract) that preclude use of barium or use of an endoscopy. If no treatment is warranted, then the SLP may make recommendations about the safest course of intake (and still document the risks of such action) and may provide training to caregivers and family, as appropriate. Parkinsonism & Related Disorders, 18(4), 311315. Chest, 137(3), 665673. https://doi.org/10.1007/s00455-014-9551-8, Riquelme, L. F. (2004). Kalf, J. G., de Swart, B. J. M., Bloem, B. R., & Munneke, M. (2012). European Neurology, 38, 4952. Dysphagia: Clinical management in adults and children. Swallow while squeezing your throat as hard as you can (pretend that you're swallowing a whole grape) Repeat to fatigue (or in sets of 5-10 swallows, as appropriate) You can also prompt patients to press their tongue hard against their palate . Cognitive deficits (e.g., impulsivity, decreased initiation) may affect a patients pace during meals. See the Assessment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Clinical Rehabilitation, 31(8), 11161125. Swallow while keeping your tongue gently between your teeth. In addition to determining the type of assessment and treatment that is optimal for adults with dysphagia, SLPs consider other service delivery variables that may affect swallowing outcomesvariables such as format, provider, dosage, and timing. Ultrasound imaging and swallowing. Special considerations may need to be made regarding PPE for COVID-19. Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety. combines voluntary airway protection with strength building of effortful swallow (tilts aryteoinds anteriorly, closes the true and false VF) voice quality check. Keep your shoulders flat. Whiplash-associated dysphagia and dysphonia: A scoping review. The effects of lingual exercise in stroke patients with dysphagia. Kangaroo - Effortful Swallow. Mold, J., Reed, L., Davis, A., Allen, M., Decktor, D., & Robinson, M. (1991). The physician is ultimately responsible for selecting which type of tube is used, but a brief description of several options is provided below. Fiberoptic endoscopic examination of swallowing safety: A new procedure. One model for ethical decision making includes consideration of the following (Jonsen et al., 1992): Clinicians provide information regarding these considerations without factoring in their own personal beliefs. Objectives: This study aimed to identify the effect of effortful swallowing combined with neuromuscular electrical stimulation as a novel treatment approach in dysphagic patients . Leibovitz, A., Baumoehl, Y., Lubart, E., Yaina, A., Platinovitz, N., & Segal, R. (2007). The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. https://doi.org/10.1136/bmj.300.6726.721, Bock, J. M., Varadarajan, V., Brawley, M. C., & Blumin, J. H. (2017). Acta Neurologica Scandinavica, 105(1), 4043. Dysphagia in multiple sclerosis. Patients may also require further assessment or reassessment depending on changes in functional or medical status. A., Kahrilas, P. J., Kobara, M., & Vakil, N. B. You do not have JavaScript Enabled on this browser. Dysphagia in the elderly. https://doi.org/10.1136/jnnp.2004.038430, Loeb, M., McGeer, A., McArthur, M., Walter, S., & Simor, A. E. (1999). (2009) found that dysphagia occurs in over one third of patients admitted to stroke rehabilitation units. Acta Gastroenterologica Latinoamericana, 40(2), 156158. (2018). B., Yoo, S. J., Chang, M. Y., Lee, S. W., & Park, J. S. (2017). General contraindications for an instrumental exam include, but are not limited to, the following: . Springer. Critical Care Medicine, 41(10), 23962405. (1989). 243259). (2023). https://doi.org/10.1016/j.parkreldis.2011.11.006. multiple sclerosis (De Pauw et al., 2002); amyotrophic lateral sclerosis (ALS, Lou Gehrigs disease; e.g., Ruoppolo et al., 2013); muscular dystrophy (e.g., Tabor et al., 2018); developmental disabilities in an adult population (e.g., intellectual disability; Chadwick & Jolliffe, 2009); post-polio syndrome (e.g., Sonies & Dalakas, 1991); myasthenia gravis (e.g., Llabrs et al., 2005; Romo Gonzlez et al., 2010); and. Each year, approximately one in 25 adults will experience a swallowing problem in the United States (Bhattacharyya, 2014). In clinical settings, SLPs typically use one of two types of instrumental evaluation: the videofluoroscopic swallowing study (VFSS) or the flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing. (2020). An SLPs roles include. Otolaryngologic Clinics of North America, 46(6), 10591071. The incidence of dysphagia following endotracheal intubation: A systematic review. As with any treatment, if it is powerful . How to Perform: While dry swallowing, squeeze all of the muscles associated with swallowing as hard as possible. overall physical, social, behavioral, and cognitive/communicative status; the patients perception of function, severity, change in functional status, and quality of life; physiological status and vital signs, including heart rate, oxygen saturation, and respiratory rate as well as respiratory/swallowing pattern, which may vary across individuals and across the life span (Martin-Harris et al., 2005); secretion management skills, which might include frequency and adequacy of spontaneous saliva swallowing and the ability to swallow voluntarily; labial seal, anterior spillage and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence; behavioral signs and symptoms, such as throat clearing or coughing before/during/after the swallow, which may not always be indicators of penetration and/or aspiration; the impact of fatigue and/or respiratory function on swallowing; changes to physiological status/vital signs/voice quality; and. https://doi.org/10.1111/joor.12461. Dysphagia, 31(3), 424433. Please see ASHAs resource on Alternative Nutrition and Hydration in Dysphagia Care for further information. Interprofessional practice (IPP) is critical to successfully achieving the desired improvements and outcomes due to complexities of assessment and treatment of swallowing disorders. https://doi.org/10.1513/AnnalsATS.201606-455OC, Blow, M., Olsson, R., & Ekberg, O. (2013). (2017). Patients who are tactically defensive may need approaches that reduce the level of sensory input initially, with incremental increases as tolerance improves. Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review. (2004). The natural history and functional consequences of dysphagia after hemispheric stroke. Qualified SLPs may also screen for esophageal motility and gastroesophageal reflux disease (GERD) to identify the need for appropriate referral. The vocal fold adductor muscles also co-contract when you develop high . Some techniques may be used for both compensatory and rehabilitative purposes. Please see ASHAs Practice Portal page on Telepractice for further detail. All screening procedures include communication of results and recommendations to the team responsible for the individuals care and to the patient and caregivers. Gastroenterology & Hepatology, 9(5), 311313. The purpose of the instrumental examination is to enable the SLP to perform the following tasks: Implementation of any instrumental procedure requires the SLP to have advanced knowledge and specific skills in order to. Steele, C., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Cultural competence in dysphagia. How To Do The Effortful Swallow. Postural techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. This treatment option is most often used with patients following treatment for head and neck cancer; however, it may be implemented with other patients suffering from similar challenges. The manometric examination revealed a markedly elevated resting peak UES pressure and greatly elevated pharyngeal pressures (approximately 250 mmHg). Deglutition disorders as a consequence of head and neck cancer therapies: A systematic review and meta-analysis. (2017). SLPs also recognize causes and signs/symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and management. Effect of cold water on esophageal motility in patients with achalasia and non-obstructive dysphagia: A high-resolution manometry study. International Journal of Otolaryngology, 2012, Article 157630. https://doi.org/10.1155/2012/157630. Krekeler, B. N., Broadfoot, C. K., Johnson, S., Connor, N. P., & Rogus-Pulia, N. (2018). Stroke, 30, 744748. Sensory stimulation may be useful for those with reduced response, overactive response, or limited opportunity for sensory experience. Journal of Hospital Medicine, 10(4), 256265. https://doi.org/10.1007/s00455-020-10137-8, Suiter, D. M., & Gosa, M. M. (2019). Dehydration among long-term care elderly patients with oropharyngeal dysphagia. The primary goals of dysphagia intervention are to. Journal of Oral Rehabilitation, 44(1), 5964. As a member of the interprofessional team, the SLP may contribute to decision making regarding the use of alternative nutrition and hydration. Suiter, D. et al. Journal of Intellectual Disability Research, 53(1), 2943. A. Patients and caregivers may not agree with clinical recommendations and may feel that these recommendations do not provide the best quality of life for their loved one. 8), S1S10. Nutrition Journal,12(1), 1-8. Pharmacotherapy, 19(8), 974978. Clinicians consult with the patients and care partners to identify patient preferences and values for food when discussing modifications to oral intake. structural assessment of the face, jaw, lips, tongue, hard and soft palate, oropharynx, and oral mucosa; functional assessment of muscles and structures used in swallowing, including symmetry, sensation, strength, tone, range and rate of motion, and coordination of movement; analysis of headneck control, posture, oral reflexes, and involuntary movements; and. Secondly, the effects of the EPG as an exercise are unknown as our study was conduced on healthy subjects without dysphagia. Recently, the addition of high-resolution manometry (HRM) has enabled the SLP to evaluate In studies in which improvement in swallowing has been identified [90], VitalStimTM was paired with effortful swallow for 1 h sessions completed 5 days per week for 3 weeks. A., Hewitt, A. L., Gentry, L. R., & Taylor, A. J. https://doi.org/10.1097/PHM.0000000000001397, Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. https://doi.org/10.1055/s-0035-1564721, Saito, T., Hayashi, K., Nakazawa, H., Yagihashi, F., Oikawa, L. O., & Ota, T. (2017). Whelan, K. (2001). This study was performed on 34 healthy wo Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. Patient adherence to dysphagia recommendations: A systematic review [published correction appears in Dysphagia, May 4, 2018]. However, clinicians were not concerned about the possible effects of this rehabilitation protocol on cardiac events. (2019). Alterations to swallowing physiology as the result of effortful swallowing in healthy seniors. These patients may have complex medical conditions related to feeding and swallowing. https://doi.org/10.1055/s-0032-1320040. American Journal of Speech-Language Pathology, 18(4), 361375. Decision making must take into account many factors about each individuals overall status and prognosis. Setting refers to the location of treatment (e.g., home-based, community-based). recurring pneumonia. Please see ASHAs resource on the Videofluroscopic Swallowing Study for further information on the VFSS. https://doi.org/10.1007/BF02414429, Langmore, S. E., & Pisegna, J. M. (2015). Bedside diagnosis of dysphagia: A systematic review. Gather saliva in your mouth or take a sip of water. Supportive Care in Cancer, 27, 36813700. Malnutrition, dehydration, and ancillary feeding options in dysphagia patients. Patients are instructed to swallow hard. https://doi.org/10.1001/archotol.130.2.208, Elvevi, A., Bravi, I., Mauro, A., Pugliese, D., Tenca, A., Cortinovis, I., Milani, S., Conte, D., & Penagini, R. (2014). Developing the tongue holding maneuver. Garand, K. L., McCullough, G., Crary, M., Arvedson, J. C., & Dodrill, P. (2020). Or hold this position for 1 minute, and then lower your head and . Treatment of dysphagia may include restoration of normal swallow function (rehabilitative) and/or modifications to diet consistency and patient behavior (compensatory). However, other parties (e.g., state regulatory agencies) may require a radiologist to be present during the VFSS. The effortful swallow is designed to improve posterior tongue-base movement, in that way improving clearance of the bolus from the valleculae. Dysphagia management in acute and sub-acute stroke. Miles, A., McFarlane, M., Scott, S., & Hunting, A. Dysphagia, 6(4), 187192. Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy require instrumental assessment. Treatment options should be selected on a case-by-case basis as there are many etiologies of dysphagia. Provider refers to the person providing the assessment or treatment (e.g., SLP, trained volunteer, caregiver). A review of medical/clinical records, including the potential impact of medications and treatment of other medical diagnoses such as. In B. Jones (Ed. Postural techniques may be appropriate to use with patients with neurological impairments, head and neck cancer resections, and other structure damage. Swallowing disorders in Sjgrens syndrome: Prevalence, risk factors, and effects on quality of life. Swallowing screening is a procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional and/or medical services (ASHA, 2004). Swallow normally, but tightly squeeze your tongue and throat muscles throughout the swallow.
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