Dysphagia Practice in 2035: Beyond Fluorography, Thickener, and Electrical Stimulation

Abstract

Dysphagia evaluation and management has rapidly become the primary practice area of medical speech pathologists since its adoption in our field less than three decades ago. As a specialty, swallowing and swallowing disorders comprise the largest represented discipline with 10,059 specialty interest group members within the American Speech-Language-Hearing Association and 298 board-certified specialists in the American Speech Hearing Association. There are national and international organizations, such as the Dysphagia Research Society and its interdisciplinary journal Dysphagia, that provide continuing education for clinicians and a platform for dysphagia researchers. Despite this rapid growth, herein we identify some significant needs for improving the science and practice of dysphagia clinical care, including a deeper understanding of physiology and neurophysiology, standardization of evaluation, consensus on core sets of dysphagia parameters for clinical and research reporting, personalized algorithms for implementation of evidenced-based practice, metrics for therapy efficacy, and increased buy-in and funding from agencies. The goals of this article are to summarize the status quo of dysphagia research, evaluation, and treatment as well as to make predictions about the future. Medical trends that we speculate will influence dysphagia research and care in the future include, among others, imaging advances, personalized medicine, regenerative medicine, and telehealth.

Mapping acute lesion locations to physiological swallow impairments after stroke

“…We sought to provide clinicians with information to improve their ability to diagnose, treat and predict physiological swallow impairment after stroke. Hereby, we responded to recent and urgent requests for further investigations of the complex role of supratentorial brain regions in swallow physiology that can promote a shift of dysphagia diagnostics and treatment from targeting symptoms to neurophysiological underpinnings (Ciucci et al, 2016).…”

Identification of Swallowing Tasks From a Modified Barium Swallow Study That Optimize the Detection of Physiological Impairment

“…Varied practices in the application of these swallowing tasks and bolus characteristics likely lead to varied results (Ciucci et al, 2016). Our goal was to identify which swallowing task or tasks yielded the worst performance during a standardized MBSS in order to optimize the detection of swallowing impairment.…”

“…Because standardized health care practices, including diagnostic procedures and interventions, have been shown to optimize patient safety and outcomes, attempts have been made to standardize the MBSS to facilitate transparency in data acquisition and reproducibility of diagnostic information across clinics and laboratories (Agency for Healthcare Research and Quality, 2003;Ciucci, Jones, Malandraki, & Hutcheson, 2016;Clave & Shaker, 2015). Doing so has allowed for the consistent identification of physiological impairment(s) and the development of treatment plans known to effect positive change in swallowing physiology (Jaffer, Ng, Au, & Steele, 2015;Logemann, 1987;Martin-Harris et al, 2008;Palmer, Kuhlemeier, Tippett, & Lynch, 1993).…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…It is clear from the above, that there are a number of rehabilitation/prehabilitation programs available [285] and several novel developments on the horizon for which a useful overview is provided by Cuicci and colleagues [289]. Two of the more commonly used programs include Pharyngocize [283], a standardized high-intensity swallow exercise program including exercise and diet modification administered daily by the therapist throughout the duration of (C)RT; and the McNeil Dysphagia Program [290] which incorporates principles of progressive resistance and load.…”

“…At present, we have limited high-quality evidence from empirical studies to inform practice around the best timing and the optimal dose for swallowing exercises, but research in this field is at an exciting phase and continues to incrementally improve our understanding and knowledge of the benefit of swallowing exercises in people with HNC. Furthermore, we are entering a new era of technology and practice advancement with many research innovations emerging [289]. The choice of potential exercise interventions for clinicians working with this population of patients is therefore quite varied.…”