Abstract

Two types of neurologic disorders affect swallowing: conditions that occur suddenly and from which the patient can be expected to recover at least partially, such as stroke, head trauma, etc. and conditions that are degenerative in nature and will cause gradual deterioration in swallowing ability over time. Of stroke patients 51–57% may have swallowing problems. In the multidisciplinary team, the initial treatment of the dysphagic patient is usually provided by the swallowing therapist in cooperation with other specialists. Swallowing therapy comprises active exercise, sensory stimulation and compensatory strategies. Decision making about therapy must be based on diagnostic procedures and not only on screening (looking for signs and symptoms). Definitive diagnostic procedures are fluoroscopy, ultrasound and manometry, while screening procedures are cervical auscultation and tests measuring swallowing speed. Swallowing therapy is divided into direct therapy (diet, postural techniques, swallow manoeuvres) and indirect therapy (increasing sensory input including thermal-tactile stimulation – TTS). Studies of TTS in the Clinic of Sports Medicine and Rehabilitation of Tartu University Hospital have shown the effectiveness of the speed of triggering the pharyngeal swallow and vomit reflex.