Monday, June 25, 2012

The Swallow Breakdown

When I first meet Nicholas, the intention was simply to observe his physical therapy sessions.  Upon learning that he had speech therapy following PT, and with an invitation by his mother, Carol, and grandmother, Mimi, I decided to observe both.  I had no earthly idea what I was in for when it came to the speech therapy observation!

Michele Clouse, Nicholas’ speech therapist, has worked with Nicholas on his swallow challenges since he was approximately one year old.   Dysphagia is a Greek word that means “disordered eating,” referring to the difficulty in eating as a result of disruption in the swallowing process.  This condition is dangerous because there is always a risk of aspiration (taking food or water into the lungs) which causes pneumonia, dehydration and malnutrition, and choking.

Dysphagia affects one’s ability to manipulate the tongue. The next time you eat or drink something, pay close attention to what goes on inside your mouth.  Your mouth opens to take the bite of food.  Your jaws operate to move up and down to chew.  Most importantly, and without any conscious effort, your tongue moves the food around in your mouth: to get to the molars that grind tougher foods;  shifting food that’s stuck in the middle or front of your mouth not getting chewed;  pushing food in the front of your mouth to the back molars to be chewed.  Your tongue is constantly in motion but you and I don’t give that much thought to the effort because it’s automatic.  We learned this swallowing process as babies; our swallow is instinctive from when we first take a bottle.  As we moved from bottles to baby food to solid food, our swallow becomes more sophisticated.

Okay, now that you’ve chewed, try not to swallow.  What’s happening?  Saliva is activated by taste, even the smell of food, and begins to accumulate along with the chewed food in your mouth.  If you think about swallowing too much, you may find yourself having trouble actually swallowing!  But if you manage to make that swallow, you’ll notice the tongue again shifts, kind of like doing a wave in your throat, from front to back.  It presses down in the front as it prepares to open the esophageal passageway (because if it was wide open all the time, whatever we put in our mouth would simply slide down with no control, thus the risk for aspiration!) then waves to the back to push the food down the throat.  Crazy, isn’t it?  Our tongue serves as a major muscle in the eating and drinking process.  Without its function, we can’t swallow. 

With only a snippet of familiarity of Nick’s case, I’m going into speech therapy with Nicholas thinking he’s going to get some help with the pronunciation of his vowels and consonants.  Wrong!  What I didn’t realize is dysphagia is a big piece of the verbal interference.  Our tongue, along with our lips and jaws, supports our ability to pronounce and sound out the letters against our teeth, via the form of our mouth, for example, when saying “o.”  I had no idea that speech therapy also involved working with swallowing issues.  The dots in my understanding started connecting into a clearer picture of what all our therapists do at the Green Therapy Pavilion. I’m willing to bet you didn’t expect to learn so much about your mouth, tongue, and swallowing, did you? 

Nicholas, Carol, Mimi, and I move into a small therapy room where Michele awaits his arrival with this big machine.  Little did I know our adventure would gets even more interesting, and eventually messier!

In the Next Blog Entry: The Jaw Jitterbug - Nicholas stiffens, his body, especially his upper torso rocking backward in response.  This effort causes mild duress, would even upset him . . . .”

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