Occupational Therapy:
A Vital Role in Dysphagia Care
Dysphagia is “dysfunction in any stage or process
of eating. It includes any difficulty in the passage of food, liquid, or
medicine, during any stage of swallowing that impairs the client’s ability to
swallow independently or safely” (AOTA, 2003a.) Recent data indicates that
dysphagia (i.e., difficulty swallowing) affects 6.2 million Americans over age
60, with 300-600,000 new cases each year (AHCPR, 1999). In individuals with
cerebral palsy, dysphagia is also a significant problem, affecting 27% of the
population (Waterman, Koltai, Downey, & Cacace, 1992).
Swallowing is an essential activity of daily
living defined in the Occupational Therapy Practice Framework: Domain and
Process as Performance in an Area of Occupation (AOTA, 2002.) When swallowing is
identified as a functional deficit, it is a critical component of the
occupational therapy intervention.
Occupational therapists and occupational therapy
assistants* provide skilled care to clients of all ages with dysphagia.
Working individually and/or as a member of a
collaborative team, occupational therapy practitioners provide interventions in
a variety of settings including hospitals, rehabilitation centers, outpatient
clinics, long-term care facilities, schools, and home or community settings.
Both occupational therapists and occupational therapy assistants* provide
comprehensive rehabilitative, habilitative, and palliative dysphagia care to
clients with a variety of dysphagia diagnoses through the life span.
Occupational therapists provide screening and in-depth clinical assessment. As
part of this process, occupational therapists may assist with instrumental
dysphagia assessments including videofluoroscopy (modified barium swallows).
Occupational therapists work together with clients and caregivers to determine
mutual goals and optimal outcomes for swallowing skills. They provide focused
interventions addressing a range of components to swallowing as described in the
Occupational Therapy Practice Framework (AOTA, 2002) performance skills,
performance patterns, contexts, activity demands, and client factors.
When provided by occupational therapy
practitioners these interventions include collaboration with clients to provide:
- Individualized compensatory swallowing
strategies
- Modified diet textures
- Adapted mealtime environments
- Enhanced feeding skills
- Preparatory exercises and positioning to
clients
- Reinforcement of mealtime strategies to
clients to enhance and improve swallowing skills
- Training for caregivers in individualized
feeding and swallowing strategies to enhance eating and feeding performance
In addition, occupational therapy practitioners
offer input to other dysphagia team members regarding client performance at
mealtime and goal accomplishment. Occupational therapy practitioners utilize
environmental and behavioral strategies to optimize swallowing performance and
provide culturally sensitive interventions to clients with dysphagia.
Occupational therapy has a direct role in
dysphagia care based on knowledge and skills gained in entry-level education.
Occupational therapy practice in dysphagia care
is supported by standards requiring a strong educational foundation. The
Accreditation Council for Occupational Therapy Education (ACOTE) mandates the
entry-level occupational therapy education *Occupational therapy assistants
provide services under the supervision of an occupational therapist. curriculum
for both the occupational therapist and the occupational therapy assistant. The
broad array of coursework in entry-level occupational therapy education provides
a basis for the complex practice area of swallowing, which incorporates:
- Anatomy
- Physiology
- Diseases and disorders that affect eating and
swallowing
- Evaluation of eating/swallowing skills using
direct observation and treatment techniques to address dysfunction
Occupational therapists and occupational therapy
assistants seeking to attain advanced level proficiency or specialization in
dysphagia care use educational opportunities in academic communities, mentoring,
and continuing education experiences to enhance their competency in this area.
The American Occupational Therapy Association (AOTA)
defines occupational therapy’s role in dysphagia care through its documents and
advances competency in practice through continuing education:
- Specialized Knowledge and Skills in Eating and
Feeding for Occupational Therapy Practice paper (AOTA, 2003)— Delineates entry
and advanced competencies for both occupational therapists and occupational
therapy assistants.
Continuing Education resources for occupational therapy practitioners—
Dysphagia Care for Adults [A Self-Paced Clinical Course From AOTA]
(Avery-Smith, et al., 2003), research reports in AJOT, and clinical practice
articles in OT Practice
- AOTA’s proposed Definition of Occupational
Therapy Practice for the AOTA Model Practice Act—Delineates dysphagia
interventions in statutory language adopted by many state licensure laws
- AOTA’s Occupational Therapy Code of Ethics
(2000)—Defines standards for client care by occupational therapy practitioners
including competency, supervision of staff, and regulatory compliance
- Scope of Practice position paper (Draft
VI)—Defines scope of occupational therapy practice including interventions and
procedures for management of feeding, eating, and swallowing to enable eating
and feeding performance. AOTA is exploring feeding and swallowing intervention
specialty certification as part of its ongoing support for recognizing
advanced skills and knowledge in the area of dysphagi
References
Agency for Healthcare Policy and Research.
(1999). Diagnosis and intervention of swallowing disorders (dysphagia) in
acute-care stroke patients. Evidence Report/Technology Assessment: Number
8. Retrieved April 25, 2002, from the World Wide Web:
http://hstat.nlm.nih.gov/hq/Hquest/screen/Direct/db/14.
American Occupational Therapy Association.
(2000). Occupational therapy code of ethics (2000). American Journal
of Occupational Therapy, 54, 614–616.
American Occupational Therapy Association.
(2002). Occupational therapy practice framework: Domain and process.
American Journal of Occupational Therapy, 56, 609–639.
American Occupational Therapy Association.
(2003). Specialized knowledge and skills in eating and feeding for
occupational therapy practice. American Journal of Occupational Therapy,
57, 660–678.
American Occupational Therapy Association.
(2004a). Definition of occupational therapy practice for the AOTA Model
Practice Act [Draft]. (Available from AOTA State Affairs Department, 4720
Montgomery Lane, PO Box 31220, Bethesda, MD 20824-1220.)
American Occupational Therapy Association.
(2004b). Scope of practice [Draft VI]. (Available from AOTA Practice
Department, 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824-1220.)
Avery-Smith,W., DuBose, C. M., Ince, E.,
Kurfuerst, S., LaTella, D., & Meriano, C. (2003). Dysphagia care for adults
[A self-paced clinical course from AOTA]. Bethesda, MD: AOTA Press.
Waterman, E. T., Koltai, P. J., Downey, J. C., &
Cacace, A. T. (1992). Swallowing disorders in a population of children with
cerebral palsy. International Journal of Pediatric Otorhinolaryngology,
24(1), 63–71.
For more information, contact the American
Occupational Therapy Association, the professional society of occupational
therapy, representing nearly 35,000 occupational therapists, occupational
therapy assistants, and students working in practice, science, education, and
research.
The American Occupational Therapy Association
4720 Montgomery Lane
Bethesda, MD 20814-3425
301-652-AOTA (2682)
www.aota.org
Occupational Therapy: Skills for the Job of Living
Copyright 2004 American Occupational Therapy Association. All rights reserved.
This material may be printed and distributed without prior written consent.
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