If you’ve been experiencing problems with eating and swallowing, you’ll understand the anxiety and often embarrassment these difficulties can cause. You are not alone though.
Research suggests 90% of people with Parkinson’s struggle with eating and swallowing problems (known as dysphagia) at some point.
If these difficulties persist and are affecting your quality of life, your doctor may refer you for a clinical swallowing evaluation.
Here is everything you need to know about this evaluation, from what to expect on the day to what happens next. Veronica Clark, an independent speech and language therapist specialising in Parkinson’s and founder of Veronica Clark Speech Therapy Services, has approved this advice.
What is a clinical swallowing evaluation?
The clinical swallowing evaluation is a clinical or bedside assessment performed by a speech and language therapist (SLT), also known as a speech and language pathologist (SLP) in some countries.
The evaluation is designed to detect swallowing difficulties and to assess whether you are at a high risk of food or liquid entering the lungs (something you may hear referred to as aspiration).
The aim of the clinical swallowing evaluation is to work out the most suitable treatment strategy for you and to decide whether further diagnostic tests are needed.
What to expect at your clinical swallowing evaluation appointment
The speech and language therapist will carry out the evaluation, which includes:
- taking a medical history
- assessment of mental ability
- management of saliva
- mouth structure and function including the lips, tongue, jaw, cheeks
- assessing chewing ability
- sensation in the mouth
- function of the larynx (voice box)
- assessing the cough function
- testing the quality and timing of the conscious swallowing reflexes and testing the reflexive swallow with different food and liquid consistencies.
What happens after your clinical swallowing evaluation
After your clinical swallowing evaluation, the SLT may refer you for special tests to find out what is causing your swallowing difficulties. These are commonly either:
- Videofluoroscopy Swallowing Study (VFSS): This is a radiographic procedure (or a moving X-Ray) that monitors the swallowing process, from the moment food or liquid is taken into the mouth until it reaches the stomach. Food or drink containing barium is given in different consistencies. It is then video-recorded and observed as it progresses through the mouth, pharynx and oesophagus. During the assessment, various therapy techniques and postures can be tried out to evaluate their effectiveness.
- Fibreoptic Endoscopic Evaluation of Swallowing (FEES): This procedure is for assessing the swallowing function of the pharynx (the part of the throat that lies between the mouth and the larynx or voice-box). Here, a fibreoptic laryngoscope is passed through the nose to view the pharynx, larynx and surrounding structures when food and liquid are swallowed. The FEES provides information on how safely the individual is able to swallow – it also helps assess an individual’s response to therapeutic techniques and strategies to achieve a safe swallow.
Based on the above assessments and respective outcomes, an SLT can then work with you or your loved one to find the safest and best options for treatment and to ensure that you keep enjoying your food and drink for as long as possible.
Sometimes this will be advice and strategies that you can implement straight away. And sometimes this may also be followed by therapy exercises to improve the function of your swallowing and the muscles and coordination involved in this complex process that we call ‘swallowing’.
Find out more about Parkinson’s and swallowing problems, and diet and nutrition advice for living well with Parkinson’s.
