International Physician Update

Relearning the Act of Eating

Video fluoroscopy shows specialists the source of swallowing problems. It also allows speech pathologists to observe which techniques work best to counter such difficulties.

Speech language pathologist Molly Blaney used the technique recently with a 73-year-old heart patient to figure out why the man was repeatedly aspirating his food. Blaney watched the patient swallow a portion of barium-dyed applesauce, and there on the video saw the applesauce begin its journey toward his stomach. Then, suddenly, Blaney saw the applesauce back up past the man’s epiglottis and flow into his windpipe. Replaying the video at a slower speed, she thought she spotted the reason—a weakness in the pharyngeal contractor muscle, perhaps the result of a small stroke that had disrupted signals from the brain.

Now Blaney is teaching this patient techniques that require less reliance on the damaged muscle. It means slowing down his swallow.

“Hold your breath, swallow hard. Good, now let’s try it again, but tuck your chin this time,” she tells him.

“We try to find the least restrictive way for the patient to eat safely, and that can mean asking the person to do some pretty weird things while he’s swallowing, like head twists and chin tucks,” Blaney explains.

By repeatedly pushing his tongue against a tongue depressor, for instance, this patient can strengthen neighboring pharyngeal muscles. And practicing pulling the back of the tongue toward the throat can enhance the laryngeal rise, reducing the risk of aspiration.
“It’s all part of the relearning process—changing how we’ve done something for years,” Blaney says.