The Medical SLP

The Patient

Being a medical Speech Language Pathologist (SLP) is quite different than working in a school.   Most people know that an SLP working with children often work on sounds that are produced in an incorrect manner or language skills.  The SLP may also help with reading and reading comprehension.


Did you know that an SLP can also work on social skills with students who have difficulty with appropriate interactions with others?


An SLP may work in a pediatric hospital and work with babies and children who have swallowing difficulties.   Many babies in the NICU require SLP services to learn to eat or suck using a bottle or even with breastfeeding.


As a medical SLP, I really believe the most common phrase I hear is…..”I don’t need speech therapy.  I talk just fine.”  Seriously, if I had a penny for every time I heard that, I could retire in style.


Our name is very misleading and barely touches on the wide array of deficits the SLP can rehabilitate.  Many SLPs have speech and language in their title, but never work with either.

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Dysphagia Awareness Month

I was beyond excited that June is Dysphagia Awareness Month.  I have been planning this post for weeks in my head and then life stepped in and said, “not today.”  That “not today” lasted over a week.

To begin the summer, I ended up getting really sick.  In fact, I was sick to the point the thought of food made me worse.  Needless to say, to write about swallowing and food was not my top priority at that time!!

How are you celebrating dysphagia?  To me, the best way to celebrate is to educate.

So many people have no idea what dysphagia is.  It is imperative that we educate the public.  You never know when that ONE person you talk to may need the information.  When I check into a hotel for a continuing education event and they ask me why I’m staying, you’d better believe I tell them what I’m there for and then tell them a little about dysphagia.  People ask all the time what I do for a living.  Take that moment to tell them a little about dysphagia.

Request to speak at a local health fair.  People are there for health information.  Take advantage of educating the people regarding dysphagia, what is it, who it can affect, signs and symptoms.  The presentation can be as little as five minutes.  You can also provide information about dysphagia at the health fair.  Some county fairs will have hospital booths providing information.  Ask if you can provide information about dysphagia.

Ask to write a guest blog post or start your own blog.  When I started blogging, there were basically no dysphagia blogs.  There are plenty of speech blogs but the dysphagia blogs tend to be on the low side.  You can use a blog to share information about therapy, review journal articles or just to educate the public.

Start a journal club.  Let’s face it, we live in an evidence-based world.  Embrace it.  Learn as much as you can from the evidence to make educated decisions for your patients with dysphagia.

Take a good quality course this month.  Ianessa Humbert has a new course coming in September.  This promises to be a challenging course allowing SLPs to become better at critical thinking in dysphagia assessment and treatment.  Northern Speech Services has great courses available.  Courses are also on sale through June 14! also offers a wide variety of courses.  CIAO is another company offering some good, quality continuing education courses.  What courses would you recommend for a GREAT quality learning experience?

Make the most of Dysphagia Awareness Month, not just in June, but all year long!

What is Dysphagia

What is dysphagia?

 Dysphagia is difficulty swallowing, which can affect any phase of the swallow.  The swallow is broken down into phases, including the oral anticipatory, oral pharyngeal and esophageal.

 How do I know if I have dysphagia?

 Dysphagia symptoms can vary from person to person.  You can have one or all symptoms of dysphagia.  Some people appear asymptomatic.  We typically associate coughing with aspiration (food/drink entering the lungs) however some people silently aspirate (no cough). Some symptoms/indicators of dysphagia include, but are not limited to:

  • Weight loss
  • Drooling or increased sensation of too much saliva
  • Coughing or choking during or after eating
  • Pocketing food
  • Pneumonia
  • Changes in diet-patient induced
  • Dehydration
  • Complaint of food sticking or “not going down”
  • Respiratory changes
    **NEVER assume a person does not have dysphagia because they are not coughing**


What should I do if I am having difficulty swallowing?

 If you are experiencing any of the symptoms above, you can fill out the self-evaluation for dysphagia.  Talk to your physician and request an evaluation from a Speech Language Pathologist.

 What is a Modified or Video Fluoroscopic Swallow Study?

 A Modified Barium Swallow Study, or Video Fluoroscopic Swallow Study is an exam that is completed in the radiology suite.  The Speech Language Pathologist (SLP) in conjunction with the radiologist will give the patient multiple consistencies of food/drinks mixed with barium.  While the patient swallows, the SLP and radiologist watches the swallowing structures on the monitor to determine dysfunction of the muscles of swallowing or swallowing structures.  The exam is typically recorded for review by the SLP.

 Did you know?????

 Approximately 300,000 to 600,000 people with neurogenic disorders are diagnosed with dysphagia.

 Swallowing involves the use of 6 cranial nerves.

 Approximately 40% of patients with dysphagia silently aspirate (food goes into the lungs without choking).

 Swallowing is one of the most complex body functions, yet in the normal adult, this process is automatic, effortless and efficient, occurring an average of 600 to 1200 times per day.

 There is evidence of dysphagia in 51% of patients with acute stroke.

 Parkinson’s dysphagia develops in approximately 50% of patients.

 Patients with multiple sclerosis, approximately 34% have dysphagia.

 Some medications, such as antidepressants can cause dysphagia.

 Swallowing is performed for management of secretions and to maintain nutrition and hydration.

 What kind of evaluation may the Speech Language Pathologist complete?

  •  Bedside or clinical assessments of dysphagia include, but are not limited to:
  • Cervical Auscultation-using a stethoscope to listen to the sounds of breathing and swallowing to determine   swallowing dysfunctions.
  •   Laryngeal elevation palpation-feeling the larynx for elevation and for hyoid anterior movement during the swallow.
  •    Monitor for signs or symptoms of aspiration-the SLP will review the patient chart and monitor during swallow trials for any of the signs/symptoms of dysphagia.
  •   Trial different consistencies-the SLP will present different food and liquid consistencies to test how the patient performs with the differing consistencies and to find which consistency is safest for the patient.
  •  Pulse oximetry-the SLP may monitor the patient’s oxygen saturation levels to determine if they dip during swallowing,  which may indicate aspiration.
  •  (Pulse oximetry is unreliable in predicting aspiration)
  •  Heart rate monitoring-the SLP may watch the patient’s heartrate for increase or decrease in rate of heartbeat  during the swallow.
  • Blue dye assessment-the SLP may add blue food coloring  to food and/or liquids of a patient with a trach.  If the trach is suctioned and blue is suctioned from the trach, this is an indication that the person is aspirating.
  •  (Blue dye assessment is rarely used in practice now and has been discontinued by many facilities as it is unreliable).
  •  Three ounce water test-3 ounces of water is given to the patient, who must then drink all 3 ounces at one time without stopping.  This test is completed on a pass/fail basis.
  •   Bolus manipulation task-this assessment monitors how well a patient manipulates a bolus (bite of food) within the mouth (oral cavity).  This can also be done by rotating a tongue depressor on each side of the oral cavity.
  •  Monitor vocal sounds-after swallows involving different consistencies of food or drink, the SLP will have the patient say “ah”, monitoring for vocal changes after the swallow.

Instrumental Assessments include:

  •  Modified Barium Swallow Study/Video Fluoroscopic Swallow Study
  • FEES
  •    Manometry
  •    Ultrasound

 What kind of therapy is available for dysphagia?

There are several different treatment techniques available for dysphagia therapy.  Not all therapists are trained in each technique and some techniques are controversial due to lack of research offered.

Deep Pharyngeal Neuromuscular Stimulation (DPNS) currenty has no published, peer-reviewed research to support its use or disuse.

Therapeutic Techniques that are evidence-based and have published peer-reviewed research:

  •   Thermal-tactile stimulation
  •    Myofascial release and manual techniques
  •    Lingual exercises with resistance
  •    Exercises with resistance
  •    Manometry
  •    Neuromuscular Electrical Stimulation (NMES) 
  •    Masako
  •    Mendelsohn
  •    Shaker
  •    Supraglottic Swallow
  •    Super-Supraglottic Swallow
  •    Effortful Swallow
  •    Back of Tongue Exercises:  Yawn, Gargle, Pull tongue straight back
  •    McNeil Dysphagia Therapy Program (MDTP)
  •    Expiratory Muscle Strength Training (EMST)

  I have been recommended to have thickened liquids. What are the differences?

 There are four different liquid consistencies, thin, nectar, honey and pudding.

 Thin liquids are regular liquids such as water, tea or milk.  They need no preparation.

 Nectar thick liquids are the same consistency as syrup.  There are naturally nectar thick liquids such as buttermilk, tomato juice and fruit nectars.  Other liquids need to have thickener added to increase the viscosity and make them safe for the patient to drink.

 Honey thick liquids are the same consistency as honey.  There are no naturally honey thick liquids.  All liquids need to be prepared with thickener to be safe for the patient to swallow.

 Pudding thick liquids are as thick as pudding.  They have to be mixed with thickener and have to be spooned to swallow.