Swallowing and dysphagia therapy in Cherry Hill, NJ

Most people never think about swallowing. It happens roughly a thousand times a day without any attention at all. When it stops working properly, it takes over mealtimes, and then it starts taking over your social life.

What dysphagia is

Dysphagia (say it dis-FAY-jee-uh) is the medical term for difficulty or pain when swallowing food, liquid, medication or saliva.

It happens for lots of reasons: damage to the brain such as a stroke or brain injury, changes to the head or neck such as cancer treatment, lost teeth or badly fitting dentures, or general deconditioning after illness.

The three stages of a swallow

Swallowing is a coordinated sequence, and dysphagia can affect any part of it — or more than one part at once.

• The oral phase happens in the mouth: biting, chewing, and moving food around. Problems here look like difficulty holding food or saliva in the mouth, pocketing food in the cheeks, or taking a very long time to chew.
• The pharyngeal phase happens in the throat — this is where things “go down the wrong pipe”. Problems here look like coughing, throat clearing, a wet-sounding voice, or difficulty breathing during or after meals.
• The esophageal phase is where food is squeezed down to the stomach. Problems here can feel like a lump in the throat, or show up as acid reflux.

Signs it is time to get assessed

• Difficulty chewing
• Coughing or throat clearing when eating or drinking
• Pain when swallowing
• Difficulty coordinating breathing and swallowing
• A history of aspiration pneumonia, chest infection or unexplained fever
• Avoiding certain foods or drinks
• Weight loss, malnutrition or dehydration from not being able to eat enough

Swallowing trouble is not only a medical problem. It affects nutrition, overall health, and whether eating with other people is still something you look forward to.

Conditions we treat

• Stroke
• Parkinson’s disease
• Other neurological disorders
• Head and neck cancer
• Traumatic and acquired brain injury
• Other acquired swallowing disorders

What therapy actually involves

We start with a comprehensive evaluation to determine the signs and symptoms of dysphagia, whether further testing such as a modified barium swallow study is needed, and what treatment should target.

Treatment then runs on two tracks, usually at the same time:

• Rehabilitative — working to improve the swallow itself, through strengthening, coordination and targeted exercise.
• Compensatory — adapting how food is prepared, how you position yourself while eating, and what strategies you use, to reduce symptoms and improve safety while the rehabilitative work is going on.

The protocols we are certified in

This is the part that distinguishes a dysphagia specialist from a generalist.

• Ampcare Effective Swallowing Protocol (ESP™) — combines neuromuscular electrical stimulation, targeted exercise and clinical judgement to strengthen the muscles used in swallowing. Several of our clinicians are Ampcare certified users.
• NMES — neuromuscular electrical stimulation for swallow rehabilitation.
• MDTP — the McNeill Dysphagia Therapy Program, an exercise-based approach to swallowing rehabilitation. Our owner is a certified MDTP provider.
• EMST — expiratory muscle strength training, which builds the breath and cough strength that protect the airway.

Who this is for

• Adults and teenagers — we do not treat young children or infant feeding
• Anyone coughing, choking or clearing their throat at meals
• People who have had a stroke, brain injury or head and neck cancer
• People with Parkinson’s or another neurologic condition
• People losing weight because eating has become too difficult
• People recently discharged from hospital or a skilled nursing facility
• Families worried about a loved one’s safety at mealtimes

What the first appointment looks like

The evaluation usually takes about an hour. Here is the shape of it.

1. We talk

   You tell us what has changed and what you want to get back to. We go through your medical history. Bring your family or your caregiver if you can — they notice things you cannot.

2. We assess

   A mix of standardized tests and real, everyday tasks. For swallowing we take a full history, examine the muscles of the mouth and throat, and watch you eat and drink a range of textures. We determine whether instrumental testing such as a modified barium swallow study would change the plan.

3. We tell you what we found, the same day

   We discuss the results with you at the end of the session and build a plan together, using your goals and your real situations. You do not go away and wait for a letter.