Comprehensive Assessment of Functional Dysphagia
Presented by Jaimie Anderson
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Nonfinancial: Jaimie Anderson is a volunteer at the American Speech-Language-Hearing Association’s Special Interest Group 2, Neurogenic Communication Disorders Professional Development Committee; the Academy of Neurologic Communication Disorders and Sciences Board Certification Committee; and the Dysphagia Research Society’s Website, Communications, and Public Relations Committee. She has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Speech-language pathologists (SLPs) evaluate oropharyngeal dysphagia secondary to structural and neurologic etiologies. This includes swallowing deficits following stroke, traumatic brain injury, progressive neurogenic disease, and head and neck cancer. There is a proliferation of literature describing the typical clinical swallowing presentation in these organic disorders and how to evaluate and treat them. However, sometimes patients present with significant swallowing complaints without an identifiable organic cause. This presentation will equip the practitioner with information to identify patients with functional dysphagia. The DSM-5 criteria for functional neurologic disorders and Rome Foundation criteria for functional dysphagia will be reviewed. A modern understanding of risk factors, including gut–brain interaction, cortical changes, and a biopsychosocial model will be discussed. A multidisciplinary approach for exclusion of other diagnoses will be described, such as neurodegenerative disease, esophageal dysmotility, or structural abnormalities of the head and neck. A comprehensive evaluation of functional dysphagia, including a thorough case history, patient interview, multiphase swallowing examination, and patient-reported outcomes to identify inclusionary criteria, will be presented.
Meet your instructor
Jaimie Anderson
Jaimie Anderson is a medical speech-language pathologist (SLP) and is board certified by the Academy of Neurogenic Communication Disorders (BC-ANCDS). She currently evaluates and treats complex multiphase swallowing, voice, upper airway, and motor speech disorders as part of a multidisciplinary team at the University of South…
Chapters & learning objectives
1. Defining Functional Dysphagia
Over centuries, functional neurological disorders have had many names and explanations. Disorders such as hysteria were often diagnosed and attributed to supernatural causes. In this chapter, the DSM-5 criteria for functional neurologic disorders and Rome Foundation criteria for functional dysphagia will be reviewed. A modern understanding of risk factors, including gut–brain interaction, cortical changes, and a biopsychosocial model will be discussed.
2. Multidisciplinary Evaluation of Functional Dysphagia
In Chapter 2, a multidisciplinary approach to assessment of swallowing difficulty will be described. Evaluation of neurology, gastroenterology, or otolaryngology may be necessary. Diagnoses to be excluded may include neurodegenerative diseases, esophageal dysmotility disorders, or structural abnormalities of the head and neck.
3. Comprehensive Evaluation of Functional Dysphagia by the SLP
In this chapter, a comprehensive evaluation of swallowing by the SLP for assessment of functional dysphagia will be described, including a thorough case history, a patient interview, patient-reported outcomes, and a multiphase instrumental assessment. Positive clinical features for the diagnosis of functional dysphagia by the SLP will be highlighted.
