Multiple Sclerosis - A Practical Guide to Rehabilitation - 39

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

* Residual food on tongue or in the mouth after
swallowing
* Feeling of food or pills being "stuck" in the
throat or chest
* Increased chest congestion after eating or
drinking
* Difficulty chewing
* Changes in loudness of voice or ability to
clearly pronounce words (may be a precursor
to swallowing problems)
A recent review and meta-analysis found that the
most frequently reported symptoms of dysphagia
in people with MS were coughing/clearing the
throat (61-66%); feeling of food sticking in throat
(63%), choking on liquid/food (57%), and
spillage of food/liquid from lips or drooling
(34%).150
Common complications of dysphagia include:
* Dehydration
* Malnutrition
* Upper respiratory infections
* Aspiration pneumonia
* Reduced participation and quality of life
Malnutrition can have downstream effects on
physical health, lead to increases in fatigue,
decreases in muscle mass, and slow wound
healing. Changes in weight and muscle mass can
also affect impact mobility, activities of daily
living, and overall success of rehabilitation.151
When these changes occur it is important to
consult with a dietitian as soon as possible, to
find ways to maintain nutrition with
consideration of food and liquid texture changes
and to help limit negative health effects of
dysphagia.
Dysphagia-associated changes in participation
and quality of life are sometimes
underappreciated. People may be embarrassed by
their symptoms and may have difficulty finding
restaurant items that are comfortable to eat or
that fit diet texture modifications. The additional
time they may require to eat can change the

dynamic of mealtimes. In a culture that centers
social gatherings around food, dysphagia can be
isolating. People with MS-related dysphagia report
it as a major distraction in life. They describe
being frustrated, depressed or annoyed, having
difficulty selecting appropriate foods, and having
reduced social participation surrounding eating.150
Few assessments and screens capture such
changes. The Swallowing Quality of Life
Questionnaire (SWAL-QOL, described below) can
be used to initiate a discussion and help assess
quality of life in relation to feeding and
swallowing.
Screening Tools for Swallowing
Several screening tests are commercially available
for the evaluation of dysphagia. A recent review of
self-reported swallowing measures in neurological
disorders recommends the Eating Assessment
Tool (EAT 10) and SWAL-QOL as valid, reliable,
and easy to administer.152 However, the authors
note that the length of the SWAL-QOL may be
limiting for some individuals. The Dysphagia in
Multiple Sclerosis (DYMUS) Questionnaire was
developed specifically for MS and can be used as a
preliminary assessment.153 Each is described below.
EAT 10154
* Time to administer: 5-10 minutes
* Focused on impairment
* Can be used to assess change in swallow
function
SWAL-QoL155
* Time to administer: 15-20 minutes
* Focused on impairment, participation, and
quality of life
* Can be used to assess changes in swallow
function and quality of life
* May be lengthy and difficult to complete for
individuals with cognitive changes
DYMUS153
* Time to administer: 5-10 minutes
* Focused on impairment and body function
* Subscales for liquids and solids

Speech, Swallowing Issues, and Oral Health

39



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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