The SLP staff will determine if you are an appropriate candidate for rehabilitation of your swallowing disorder. In most cases, therapy will be recommended to begin immediately. There are instances, however, when initiation may be delayed. Some common reasons for delaying therapy include:
· Additional surgery is pending
· Additional wound healing is required
· Other more urgent health concerns are present
· Extreme physical debilitation
· Concurrent radiation treatment
In this practice, there are therapy programs designed to be home programs (conducted independently by the patient), office-based programs as well as combination programs which have both office-based and home components. The combination programs are the most commonly prescribed as these allow for continued work outside the office, while the office based-therapy provides the main work and structural framework for the treatment.
The premise for therapeutic intervention is to provide effective rehabilitation which will allow for the safest, most efficient swallowing at the highest level possible. There are frequently limitations to how much progress can be made in therapy and realistic expectations will be communicated following your initial dysphagia evaluation.
Depending on the progress you demonstrate, your course of therapy may be continued, extended or discontinued. In general, as long as improvement is being demonstrated, your therapy will continue. Once improvements are no longer made, when you have reached a therapeutic plateau, then consideration to discharge will be given. In this practice, however, a small course of therapy may be continued after maximum gains are made to ensure the long-term effectiveness of your therapy.
It is very important to understand that the continuation of therapy vs discharge from therapy is based on improvement of function and NOT what you are eating/not eating. Resuming a normal diet is NOT the goal of therapy. Rather, getting a patient to swallow as best as possible is always the goal. This may or may not include returning to a regular diet. The SLP staff is very good in explaining realistic expectations of therapy. If you have any questions in this regard, do not hesitate to ask.
Strength and Range of Motion Exercises
In many cases, a dysphagia is caused by a muscular issue, whereby certain muscles have weakened or have been surgically removed, either partially or completely. In these instances, it is critical to strengthen the muscles as much as possible. We typically provide exercises to be done at home, three times a day. These comprise either a home based program, the home component for a combination program, or even the office based program itself. The SLP staff, however, will introduce you to these exercises and ensure you are able to complete these properly before instructing you to conduct these at home. See Swallowing Exercises. The SLP staff will also determine your course of therapy in this regard.
Neuromuscular Electrical Stimulation (Vital-Stim)
In this office, the SLP staff has been FDA certified to administer this therapy modality. This is an aggressive, office-based therapy during which electrical stimulation is applied to various targeted muscles in the throat, causing involuntary contraction of the muscles. This can be very effective although the SLP staff can direct you more regarding realistic expectations from this treatment modality.
While this treatment can be very effective, it can also be painful, although it varies widely from patient to patient in this regard. The SLP staff will work with you to ensure your comfort as much as possible. There are specific instructions to follow that will ensure optimal comfort. See Vital Stim Instructions
Your progress/improvement will be monitored at regular intervals throughout your therapy. Following completion of one course of therapy (15 sessions), a swallow evaluation will be conducted. This serves several purposes:
· To determine if therapy techniques are “working”
· To identify therapy needs/goals for the next course of treatment
· To advance your diet as much as possible
If therapeutic progress is made, then swallow function should also be improving. How quickly this is happening and in what areas you are improving can vary greatly from person to person. However, once swallow ability has improved to allow for changes in what/how you are eating, the SLP staff will change your diet and intake modifications accordingly. It is important to follow these guidelines since what you eat/how you eat can also serve to augment your therapy, improving your progress even more! This is especially important if you have been cleared for therapeutic feeding (link), as this serves as a transitional phase from g-tube reliance to eating by mouth again.