2011 Annual Membership Meeting
SPEECH & SWALLOWING
Anne G. Lefton, M.A. / CCC-SLP
Nancy Sedat & Associates
“It feels like there’s something stuck in my throat!”
Swallowing

Transference of material from:
Mouth
Esophagus
Throat
Stomach
3 Phases of Swallowing



Oral
Pharyngeal
Esophageal
Normal Swallow Sequence
Normal Swallow Sequence

In the mouth:
 lips,
teeth and tongue help
prepare bolus (food mass)
for further stages of
swallowing.
Lips
Teeth
Tongue
Bolus
Normal Swallow Sequence

Access between the nasal
cavity and mouth closes
as bolus moves into
pharynx (throat).
Nasal Cavity
Pharynx
Bolus
Normal Swallow Sequence


Bolus is propelled 
esophagus
As esophagus entrance
opens: Epiglottis helps
guard against access to
the lungs.
Epiglottis
Vocal Cords
Trachea/Airway to the Lungs
Esophagus Entrance
Normal Swallow Sequence

The airway reopens and
the esophagus entrance
closes as muscle
contractions move bolus
toward stomach.
To the Stomach
Swallowing Disorders
Swallowing Disorders / Dysphagia

Oral Stage
 Difficulty
bolus
controlling, forming, or transporting a cohesive
Swallowing Disorders / Dysphagia

Pharyngeal Stage
 Pooling
or Stasis
 Aspiration
Illustrations by Elliot Sheltman from Follow the Swallow by Jo Puntil-Sheltman
Evaluation of Swallowing Function


Non-instrumental clinical evaluation
Instrumental assessment
 Modified
 aka:
Barium Swallowing Study (MBSS)
Videofluoroscopic Swallowing Examination
 Fiberoptic
Endoscopic Evaluation of Swallowing (FEES)
Thin Liquid Swallows
Puree Swallows
Cookie Swallows
Complications from Dysphagia

Pneumonia
 Risk






increases as dysphagia worsens
Choking
Longer Meal Times
Malnutrition
Dehydration
Weight Loss
Quality of Life
 Loss
of social interaction associated w/ eating
Treatment
What to Do?

Immediate remedies:
1.
2.
3.
4.
5.
If coughing/choking, never inhibit cough
Heimlich Maneuver
Stack breathing
Portable suction
CoughAssist device
[www.respironics.com]
CoughAssist™
Mechanical In-Exsufflator
Safe Swallowing Strategies

Swallowing techniques
 Don’t
talk with mouth full
 Repeat swallows
 Alternate solids and liquids
 One
 Sip
sip at a time
‘n’ tip straws
 Smaller bites
 Slowed rate
 Supervision and cueing
 Smaller, more frequent meals per day
Safe Swallowing Strategies [cont.]

Changes in food & liquid consistencies
 Avoid
problem textures and consistencies
 Gel/powder liquid thickener

Diet Hierarchy
 Steak
consistency diet
 Pot roast consistency diet
 Meat loaf consistency diet
 Pudding consistency diet
 Cream consistency diet (tube feedings)
Safe Swallowing Strategies [cont.]

Positioning
 Chin

tuck
Behavioral changes
 Reduce
distractions
 Eat more calories early in the day or when there is less
fatigue
Safe Swallowing Strategies [cont.]

Pill management
 Take
with applesauce, yogurt, pudding, ice cream, or
any other slippery medium
 Cool
Whip!
 Long-necked bottles
 Carbonated beverages
 Crush
with pharmacist’s consent
Alternative Methods of Nutrition
Feeding Tubes

G-tube goes into stomach through an opening in
skin
Feeding Tubes [cont.]

What it does:
 Provides
nutrition via an alternate route
 Allows one to receive required nutrition and hydration
when no diet texture can be swallowed safely or when
oral feeding is not meeting nutritional / hydration
needs
 Allows for the combination of oral eating for pleasure
and tube feeding for fluids and calories
Ataxia and Speech
Speech

“Normal” sounding speech requires perfect
coordination of the following systems:
 Articulatory
system (e.g., lips, tongue, etc.)
 Resonatory system (e.g., velum/soft palate)
 Phonatory system (e.g., vocal cords)
 Respiratory system (e.g., lungs)
Random Speech Facts…


Approx. 14 different
sounds produced every
second when we
verbalize.
Over 100 different
muscles coordinate
during speech.
“Its Greek to Me”

Ataxia comes from:
 Greek
word for “lack of order”
Ataxic Dysarthria

Disorder of sensorimotor control for speech
production that results from damage to cerebellum
or to its input and output pathways
Effects of Ataxia on Speech
Effects of Ataxia on Speech

Articulation: disruption of the timing, force, range,
and direction of movements.
 Imprecise
consonant articulation
 Distorted vowels
 Breakdown
is most evident during longer strings of speech
Effects of Ataxia on Speech [cont.]

Resonance:
 Hypernasality
 Hyponasality
 May
occur due to timing errors between the muscles of the
velum and the other muscles of articulation.
Soft Palate / Velum
Effects of Ataxia on Speech [cont.]

Phonation: the sound of the voice
 Harsh
 due
 Vocal
vocal quality
to decreased muscle tone
tremor
Effects of Ataxia on Speech [cont.]

Respiration:
 Uncoordinated
 Exaggerated

movements of the respiratory muscles
movements
Excessive loudness
 Paradoxical
movements (different muscle groups work
against each other)



Talking too quickly
Decreased vocal volume
Trying to talk on residual air
Most Common Speech Changes







Imprecise consonants
Excess and equal stress
Articulatory breakdown
Distorted vowels
Harsh vocal quality
Mono pitch/Mono loudness
Slowed speech rate
Treatment
What to do about it…


1. Evaluation by a Speech-Language Pathologist
2. Treatment
 Exercises
 Improve
will target the affected system(s)
breath support and coordination of breathing and
speaking
 Rate control techniques (e.g., finger/hand tapping to set the
pace of appropriate syllable production)
 Increase articulatory accuracy: over-articulate
 Develop stress and intonation skills to regulate pitch and
loudness
Compensatory Strategies
For the Speaker...
 Energy
conservation
 Minimize environmental noise/distractions
 Establish context of message
 Alter your rate of speech…SLOW it down.
 Exaggerate articulation of final consonants in words
 Use gestures/point to props
 Boil down the message
 decrease
“filler” words
 Keep important/key words
Compensatory Strategies
For the Communication Partner…
Ascertain patients preferred strategy when not intelligible
 Decrease the need for repetition  fatigue and frustration
 Ask yes/no questions
 Know the topic
 Maintain eye contact
 Give undivided attention
 Don’t interrupt or finish sentences
 Let the speaker know the parts of the message you did not
understand so s/he will not have to repeat the entire
message.
 Patience

Augmentative/Alternative
Communication (AAC)

Low tech

Communication board
Alphabet board
 Phrase board


High tech

Speech generating devices


An SLP can help explore your options
Other

Voice amplification

Chattervox OR SoniVox
Take Home Message
With regard to speech or swallowing,
there is always a way to keep you functioning
at the highest level possible.
2011 Annual Membership Meeting
THANK YOU!
Anne G. Lefton, M.A. / CCC-SLP
Nancy Sedat & Associates
References




Freed, D. (2000). Motor speech disorders diagnosis and treatment. San
Diego, CA: Singular Thomson Learning, 2000.
Puntil-Sheltman, J. (1997). Follow the swallow. Seal Beach, CA: Sheltman
Publishing, 37-40.
Rangamani, G.N., J. (2006). Managing speech and swallowing problems: A
guidebook for people with ataxia. National Ataxia Foundation, 1-60.
Yorkston, K.M., Beukelman, D.R., & Bell, K. (1988). Clinical management of
dysarthric speakers. San Diego, CA: College-Hill Press.