Karen Melvin is an experienced SLT working in the Derry/Donegal area. She specialises
in working with adults, young people and children with a learning/intellectual disability
and/or autism as well other mental health conditions. She is highly skilled in the management of dysphagia (Difficulties with Eating, Drinking, Swallowing) and SNPN Donegal caught up with her to understand more about this area.
What is Dysphagia?
Dysphagia refers to a difficulty with swallowing - we swallow to eat, drink and drain saliva. It can affect the ability to safely swallow food, drink or medication. You may also have heard dysphagia referred to as a difficulty with FEDS (Feeding, Eating, Drinking and swallowing). Swallowing is something we do without thinking on average 600-800 times a day! It’s a highly co-ordinated activity involving over 30 pairs of muscles as well as different types of nerves - we even swallow automatically when we are sleeping.
People of all ages from babies to older adults can experience dysphagia. It can occur at any point in the swallowing process, for example, from when we put food or drink into our mouths until it reaches the back of our throats and moves in the oesophagus (the food pipe) which transports food and drink to our stomachs.
What are the risks posed by a poor swallow?
Dysphagia can range from a very mild difficulty to a more significant difficulty. Some people can experience dysphagia temporarily, for others, it can be a more persistent or even a permanent issue.
If someone is experiencing dysphagia it is important to manage this as it can pose serious health risks like recurrent chest infections and dehydration. It can also be very uncomfortable for a person to experience feelings of food getting stuck, feeling like they can’t swallow or if they experience episodes of coughing and choking. This can impact on the enjoyment of eating and drinking and even raise feelings of fear around eating and drinking.
People who experience dysphagia are at risk of aspiration, which is when food or drink goes down the ‘wrong way’ into the airway and can reach the lungs. This can cause coughing/choking and recurrent chest infections and poor respiratory health in general. Aspiration can also happen silently (without any coughing for example) and the only indication might be a history of reoccurring chest infections.
Who is at risk of dysphagia?
There are some groups of people may be more likely to experience dysphagia - these include for example, people with developmental differences related to Intellectual disabilities, sensory differences, epilepsy, physical disabilities and dementia
What are the signs to look out for?
There are some indicators for dysphagia including repeated chest infections, coughing/choking during or shortly after eating or drinking, repeated urinary tract infections, drooling of saliva, increase in reluctance to eat, dehydration and weight loss.
What can we do to help adults & children with dysphagia?
There are many things that can help including encouraging good posture, taking a “little and often” approach to eating and drinking with breaks, ensuring that eating & drinking is distraction free and using smaller utensils. If you have concerns about dysphagia is important that you ask your speech & language therapist or your GP for advice.
The speech therapist can do a dysphagia assessment to diagnose and provide support.
What happens during a Speech Therapy dysphagia assessment?
As a Speech and Language therapist working with people experiencing dysphagia I work with the child/adult and their family to gain a clearer understanding of what might be causing the difficulties with eating drinking and swallowing. This includes observing the person during a mealtime to get a better understanding and clear visual picture of their eating pattern and swallowing function. Sometimes I might make recommendations in relation to the textures of foods that may be better for the individual person to manage. This is always fully discussed with the person and their family as it is important this works really well.
Being able to enjoy mealtimes and favourite foods is an important part of many of our lives and contributes to overall wellbeing. Changes or modifications in diet should always be discussed with each individual person and their family to collaboratively agree the best way forward. Ideally Speech and Language Therapists work with other members of a multi-disciplinary team for example, Dietician, Physiotherapist, Occupational Therapist and any other relevant people involved in caring for someone to support someone with dysphagia holistically.
Tell us a little bit about yourself and your experience Karen...
I’ve worked as a speech therapist for over 18 years and am both HCPC & CORU registered. I am passionate about kind, sensitive support for people with communication differences. I focus on each person’s unique communication strengths and support the people I work with and their families through neuro-affirming care.
Understanding everyone’s lived experience is central to my work and approach. I have personal experience with autism, ADHD and learning/physical disability within my own family. This has shaped me as a professional and it is why I am so personally invested in supporting other professionals and organisations to fully understand and support people with differences in communication.
Karen is available for appointments 1:1 in clinic or in a work/school/ home environment either side of the Derry/Donegal border. She can be contacted at karenmelvin.slt@gmail.com