Dysphagia

for health and social care professionals logo Management-of-MND---dysphagia

This information is for health and social care professionals. You may also want to see our information for people living with or affected by MND on:

Motor neurone disease (MND) is a progressive and terminal disease that results in degeneration of the motor neurones, or nerves, in the brain and spinal cord.

Swallowing problems affect at least two-thirds of all people with MND during the course of their illness.

When a patient presents with this symptom, deterioration is inevitable and referral to appropriate professionals should be made without delay.

There may be times when a person with dysphagia will have episodes of coughing and choking. Even though a choking episode is very distressing for them and their carer at the time, they can be reassured that it is virtually never a direct cause of death.

Cause

Spasticity, largely resulting in weakness of the:

  • tongue
  • lips
  • facial muscles
  • pharynx and larynx.

Effect

Problems swallowing liquids results in coughing when drinking. This may be the first sign of early dysphagia.

Other signs include:

  • loss of ability to form lip seal, chew food with the tongue and/or form a bolus
  • poor or absent swallow reflex
  • food not moving to the back of the mouth or disappearing down the throat due to a poor or absent swallow reflex, or an uncoordinated swallow caused by weak pharyngeal muscles
  • muscle spasm
  • more time needed for chewing, several swallows needed for each mouthful of food and becoming tired on eating and drinking
  • a wet or muffled sounding voice after eating.

This can result in:

There may be a social impact, too: the person with MND may feel unable to eat with other people due to dysphagia. They may join others and take a few spoonfuls, while eating most of their meal before or afterwards.

Management

Assess nutritional intake and weight. Weight loss is often related to dysphagia but may also be due to upper limb weakness or general fatigue.

A dietitian can suggest strategies for managing this, including altered meal patterns (eg eating little and often). An early referral is beneficial for dietetic advice and support.

A speech and language therapist can assess ability to eat and swallow and can monitor for changes. They may suggest altering the consistency of the diet and/or suggest prescribing thickeners for fluids.

A physiotherapist or occupational therapist can advise on head supports and positioning.

Useful resources

More information can be found in our information sheet for health and social care professionals:

• Dysphagia in motor neurone disease information sheet

NICE Guideline 42 – Motor neurone disease: assessment and management

 

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