Prepared by The Professional Advocacy Committee
Special Interest Division 13 Swallowing and Swallowing Disorders (Dysphagia)
American Speech-Language-Hearing Association
This review of dysphagia teams was developed to assist speech-language pathologists and other health care professionals to better understand the responsibilities and relationships within the dysphagia team and to recognize the difference between team collaboration and cross-training of professional skills.
The 2001 ASHA document titled Knowledge and Skills Needed by Speech Language Pathologists Providing Services to Individuals with Swallowing and/or Feeding Disorders* outlines the roles of the speech-language pathologist in treating feeding and swallowing disorders. The "Knowledge and Skills" document specifically describes the expectation that the speech-language pathologist should demonstrate knowledge and skills in management of and/or participation in a swallowing team.
This document was created from the perspective of the speech-language pathologist in any setting where dysphagia management and services might be provided.
The Dysphagia Team
Individuals with dysphagia (feeding and swallowing difficulties) may have multiple medical problems and need assessment and treatment in a variety of settings (e.g. school, home, hospital, skilled nursing facility. The causes of dysphagia and consequences of dysphagia cross the traditional boundaries between professional disciplines and may require the input of multiple medical or therapeutic specialists. The mouth, throat, upper airway, larynx, trachea, esophagus and stomach are all involved in feeding and swallowing. Individuals with complex issues are best managed by a multidisciplinary or interdisciplinary team of specialists. These specialists work together and with the patient/student and family to achieve the best outcome.
The dysphagia team is led by a coordinator who is frequently a Speech-Language Pathologist. Skills needed to manage a team include: identification of core team members and support services; facilitation of team communication; maintenance of team focus, communication and interaction; documentation of team activity; and use of appropriate consultation procedures with other team members and other services.
Team members may either see the patient/student together and make joint recommendations or may participate as individual consultants. When participating as an individual, the team member who sees the patient/student initially will refer to other members of the team for assessment as needed. The presence of a dysphagia team may increase awareness of dysphagia issues throughout the medical center or practice setting. A team may be involved with inpatients as well as outpatients, with children or adults. They may be seen in a hospital or office practice, in the home or in school settings. When children are being treated, all members of the team should be specialists in pediatrics.
Dysphagia complaints that may be received or observed by members of the dysphagia team may include food refusal, impaired chewing, difficulty with more advanced food textures, coughing or choking when eating, sensation of food stuck in the throat, chronic respiratory congestion, history of pneumonia, asthma and weight loss or inadequate weight gain.
Below is an alphabetical list of specialists who may participate as members of a dysphagia team. This list is not all inclusive. Additionally, the contributions of the team member might include but not be limited to the following:
Dentist: Evaluates and treats gingival and dental dysfunction, and may specialize in prosthetics to improve swallowing.
Family Member and/or Caregiver: Provides information to other team members about the patient/student’s signs and symptoms of the disorder; demonstrates understanding and implements the recommended management techniques.
Gastroenterologist: Determines any difficulties with the GI tract; performs diagnostic tests related to the esophageal segment of swallowing; and places feeding tubes if the patient/student needs an alternative to oral feeding.
Neonatologist: Identifies infants with swallowing disorders; refers for evaluation; orders interventions as recommended; and oversees the infant’s progress.
Neurologist: Diagnoses and treats neurological causes of swallowing problems.
Nursing: Works with the patient/student and caregivers in implementing and maintaining safe swallowing techniques and compensatory or facilitation strategies during meals and when taking medications.
Nutritionist/Dietician: Evaluates nutritional needs; follows therapy recommendations regarding consistencies of liquids and solid foods, determines needs for special diets; and ensures adequate nutrition when using alternative means of nutrition.
Occupational Therapist: Evaluates and treats sensory and motor impairments and assesses prosthetic needs related to self-feeding and swallowing.
Otolaryngologist: Diagnoses and treats oral, pharyngeal, laryngeal and tracheal pathologies that may cause or contribute to swallowing problems; cooperates with speech-language pathologist in performing endoscopic evaluations of swallowing (FEES ®.)
Patient/Student: Provides information to other team members about his/her disorder; demonstrates understanding of the causes and treatment of the dysphagia disorder; follows dietary, compensatory and facilitative techniques to restore swallowing function and maintain adequate nutrition and hydration.
Pediatrician: Identifies children with swallowing problems; makes appropriate referrals; integrates recommendations of the dysphagia team with the overall health care and wellbeing of the child.
Physiatrist: May coordinate the Rehabilitation Team during the patient/student’s recovery from acute illness and may follow those with chronic diseases associated with dysphagia on an ongoing basis.
Physical Therapist: Evaluates and treats body positioning, sensory and motor movements necessary for safe and efficient swallowing, recommends appropriate seating equipment needed during feeding.
Psychologist: Evaluates and treats patient/students and their families in adjusting to dysphagia disability, in coping with ramifications of swallowing disorders, and in managing associated stresses; participates on teams treating children with behavioral feeding disorders.
Pulmonologist: Evaluates and treats respiratory complications of patients/students with dysphagia; manages chronic pulmonary diseases and patients/students who are ventilator dependent.
Radiation Oncologist: Implements radiation therapy protocols to treat patients/students with cancers of the mouth, throat and/or esophagus that may cause dysphagia.
Radiologist: Evaluates swallowing problems through radiologic studies, primarily with Speech-Language Pathologists during videofluorographic swallow studies (VFSS.)
Social Worker: Assists and counsels patient/student and families in adjustment to disability, access to the least restrictive residential and treatment environments, and third-party payment issues.
Speech-Language Pathologist: Evaluates and treats patients/students with swallowing problems, including direct modifications of physiologic responses and indirect approaches such as diet modification.
*American Speech-Language-Hearing Association. (2002). Knowledge and Skills Needed by Speech Language Pathologists Providing Services to Individuals with Swallowing and/or Feeding Disorders. ASHA supplement 22, 81-88.