Dysphagia: What We Know, What We Don't Know, and What We Do From Here

As SLPs, we're constantly navigating the world of research and evidence-based practice. We always seek the latest and greatest studies to guide our clinical decisions. But what happens when the research is lacking? What do we do when there are more questions than answers? 

A dearth of research might appear like a map thrown into the fireplace and taken out with only bits and pieces remaining. But this situation can be viewed from a different angle. Like Lewis and Clark venturing out to discover a new world and endless opportunities, SLPs are uniquely positioned to continue blazing a trail in this young field. In other words, a lack of research is not a dead end. It's an opportunity. It's a chance for us to be creative, to think outside the box, and to find new and innovative ways to help our patients.

What We Know

Don’t let the introduction fool you. The fact that the jury is still out on many tough questions in our field doesn’t mean that we haven’t already answered A LOT. Our researchers work tirelessly to get us the information we need, and we’re now standing on the shoulders of giants, able to see way more of the landscape than even just a few years ago.

So let's start with the basics. Below are some things we know for sure in dysphagia management; the widely accepted truths that can help us as a starting point…

• Oral care is essential. Good oral hygiene can help reduce the risk of aspiration pneumonia and other complications. I firmly believe that giving a toothbrush to a patient can have a far greater impact on the patient’s overall health than any diet modification can.

• Swallowing exercises can help improve swallowing and overall function. Strengthening the muscles involved in swallowing can improve swallowing function and reduce the risk of aspiration. It can also enhance PO tolerance and comfort during meals.

• A comprehensive swallow assessment must include an instrumental study (MBSS or FEES). We’ve learned that the clinical swallow assessment is extremely limited in giving us accurate information about the swallow. Without imaging of the oropharyngeal anatomy and physiology, we cannot make an effective judgment of the swallow's status, safety, or efficiency. If you don’t know, imaging is the way to go.

• Certain factors increase the risk of aspiration pneumonia. There are many risk factors we’ve accumulated to help us navigate the greatest dangers of dysphagia. Studying these variables helps us pinpoint the patient populations we need to monitor closely and manage carefully. Some of the variables that frequently pop up include: 

• Cognitive deficits

• Dysphagia

• GI complications

• Functional dependence

• Poor oral health

• Poor positioning 

• Respiratory insufficiency

• Weakness/frailty 

• Age

What We Don't Know

Despite the knowledge we've gained, there's still a lot we don't know about dysphagia. Here are just a few of the unanswered questions:

• What is the relationship between dysphagia, aspiration, and pneumonia?

• How does reducing the risk of aspiration impact pulmonary health and function? 

• Do the risks of modified diets and liquids outweigh their costs? 

• Which dysphagia interventions are most effective, and for which patients? 

What We Do From Here

So, how do we move forward in the face of uncertainty? Here are a few suggestions:

• Stay curious. Keep asking questions and seeking new information.

• Be creative. If the risks are low, try new approaches and think outside the box (within reason). Then, document what you find and communicate with our researchers so they can help study your theories.

• Collaborate. Share your experiences and ideas with other SLPs and other members of the interdisciplinary team. Never grow complacent. Question others, and welcome your colleagues' questioning. If you’re not pushing others and yourself to the point of discomfort, you’re not stretching your potential.

• Advocate for more research. Support, conduct, and participate in studies that can help us better understand and treat dysphagia. Hint: it doesn’t have to be a 3-year-long monstrosity to help move the needle forward. 

A lack of research is not a roadblock; it's an open door to new possibilities. By embracing our curiosity and creativity, we can continue learning, growing, and providing our patients with the best possible care.

What are YOUR thoughts on the biggest unanswered questions in dysphagia management? Share your insights and experiences in the comments below!

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