Manual of Clinical Nutrition

Dysphagia

Manual of Clinical Nutrition Management III- 37 Copyright © 2013 Compass Group, Inc.

RELATIONSHIP OF DYSPHAGIA TO THE NORMAL SWALLOW

Phase Description of Normal Swallowing Dysphagia Signs and
Symptoms

Dietary Considerations

1.

2.

Oral preparatory phase: food is

manipulated in the mouth and

masticated if necessary

Oral or voluntary phase: the tongue

propels the food posteriorly

Drooling

Inability to form bolus

Pocketing food

Prolonged chewing and

swallowing latency

Marked prolongation of the

feeding process

Use semisolid consistencies

that form a cohesive bolus;

avoid thin liquids

Use semisolid consistencies

to form a bolus; use moist,

well-lubricated foods

Avoid foods with more than

one texture; position food

in sensitive areas; use cold,

highly seasoned, flavorful

food; try dense foods.

Use highly textured foods

(eg, diced, cooked

vegetables and diced fruit);

try dense cohesive foods;

avoid sticky or bulky

foods; assess ability to

control liquids

Use cohesive foods

3. Pharyngeal phase: begins with the
   triggering of the swallow reflex

a. Elevation and retraction of the

soft palate and complete closure

of the velopharyngeal port to

prevent material from entering

the nasal cavity

b. Initiation of pharyngeal

movement

c. Elevation and closure of the

larynx and all three sphincters

(epiglottis, false folds, and true

folds)

d. Relaxation of the

crycopharyngeal sphincter to

allow the material to pass from

the pharynx to the esophagus

Choking or coughing on

liquid and/or solids

Wet and gurgly vocal

quality

Nasal regurgitation

Struggle behavior (feel for

laryngeal elevation)

Use cohesive foods

Include cohesive semisolid

foods and thickened

liquids

Use soft solids and thick to

spoon-thick liquids; avoid

sticky and bulky foods that

tend to fall apart

4. Esophageal phase: bolus moves from
   the esophagus to the stomach

Note: The esophageal phase of the swallow is

not amenable to any kind of therapeutic

exercise regimen. The videofluoroscopic

study of deglutition generally does not

involve examination of the esophagus.

Indigestion

Reflux

Sensation of food lodged in

the chest

Avoid sticky and dry foods;

try dense food followed by

liquids

Use semisolid, moist foods

that maintain a cohesive

bolus

Bibliography

Diet for Dysphagia. In: Manual of Clinical Dietetics. Chicago, Ill: American Dietetic Association; 2000.

O’Gara J. Dietary adjustments and nutritional therapy during treatment for oral-pharyngeal dysphagia. Dysphagia. 1990;4:209-212.