Swallowing Therapy for Dysphagia: What to Expect
Published by Quad Therapy
Swallowing therapy for dysphagia helps people chew, swallow, and drink more safely, so food and liquid go down to the stomach instead of into the lungs. A speech-language pathologist (SLP) evaluates how you swallow, then uses exercises, safer positions, and diet changes. About 1 in 25 adults in the United States has a swallowing problem each year, according to ASHA.
Eating is family dinners, coffee with a friend, and holiday meals. When swallowing gets hard, people often eat less and skip meals with others, and families worry every time they hear a cough at the table. This guide explains the warning signs, how swallowing is evaluated, what therapy involves, and how to get swallowing therapy at home in Burbank and across Los Angeles County.
Quad Therapy Inc. is a California therapy company founded by a licensed physical therapist. We provide in-home therapy so patients can get care without clinic wait lines, and we place qualified therapists with clinics, schools, and facilities that need staff.
Key facts
About 1 in 25 U.S. adults has a swallowing problem each year, per the American Speech-Language-Hearing Association (ASHA).
37 to 78 percent of people have dysphagia after a stroke, depending on how closely it is tested, in a review of 24 studies in Stroke.
About 3 times higher pneumonia risk comes with dysphagia after stroke, and about 11 times higher when food or liquid is confirmed going into the airway.
41 trials and 2,660 people: swallowing therapy after a recent stroke probably shortened hospital stays by about 3 days, in the 2018 Cochrane review.
Over 60 percent of people in skilled nursing facilities have dysphagia, compared with 15 to 22 percent of adults over 50 living in the community.
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing. It can involve the mouth, the throat (pharynx), or the esophagus, the tube that carries food to the stomach. SLPs mainly treat problems in the mouth and throat, called oropharyngeal dysphagia. Problems lower in the esophagus are usually handled by a physician, such as a gastroenterologist.
Common causes include stroke, Parkinson's disease, dementia, multiple sclerosis, ALS, and head and neck cancer and its treatment. ASHA reports dysphagia in 29 to 64 percent of people after stroke and 35 to 82 percent of people with Parkinson's disease. A 2016 white paper from European swallowing and geriatric medicine societies calls dysphagia a geriatric syndrome, because it is so common in older adults and so often missed.
What are the signs of a swallowing problem?
The most common signs are coughing or choking during meals, a wet or gurgly voice after drinking, and food left in the mouth. Other signs include:
Throat clearing during or right after eating
Food or liquid coming out of the nose
Meals taking much longer than before
Weight loss or dehydration
Repeated chest infections or pneumonia
Some people have food or liquid go into the airway without any cough at all. This is called silent aspiration, and it is one reason a full evaluation matters. Call 911 right away if someone is choking and cannot breathe, speak, or cough.
How is swallowing evaluated?
An SLP evaluates swallowing in two main ways: a clinical swallow evaluation, and, when needed, an instrumental exam that shows the inside of the throat during a swallow.
In the clinical swallow evaluation, the SLP reviews your health history and medications, checks the lips, tongue, face, voice, and breathing, and watches you eat and drink a few textures. This evaluation can be done at home. It cannot see inside the throat, so it cannot confirm whether food is going into the airway.
Instrumental exams fill that gap:
Modified barium swallow study (MBSS), also called a videofluoroscopic swallow study. An x-ray video records you swallowing foods mixed with barium. It is done in a hospital or imaging center.
Flexible endoscopic evaluation of swallowing (FEES). A thin, flexible scope passes through the nose to view the throat. In California, an SLP needs special training verification and a physician order to perform FEES, and it must be done in a clinic, hospital, hospice, or medical group. It is not offered in the home.
The SLP evaluates how you swallow. A physician diagnoses the medical cause and treats it. If the SLP sees anything abnormal, the SLP sends it to your doctor. Under California Business and Professions Code section 2530.2, SLPs evaluate and treat swallowing disorders.
Does swallowing therapy work?
Swallowing therapy can help, but the research is still growing. In the 2018 Cochrane review of 41 trials and 2,660 people after a recent stroke, swallowing therapy probably shortened hospital stays by about 2.9 days and may have reduced the number of people who still had dysphagia or chest infections at the end of the trials. It did not change the risk of death or long-term dependency. Many trials were small, and much of the evidence was rated low or very low certainty.
Results depend on the cause. Many people regain swallowing after a stroke, while for Parkinson's disease or dementia, therapy often focuses on keeping swallowing safe as long as possible. In a randomized trial of 60 people with Parkinson's disease published in Neurology in 2010, 4 weeks of breathing-muscle training at home, 20 minutes a day, 5 days a week, improved swallow safety scores more than a sham device. This training is called expiratory muscle strength training (EMST).
What exercises are used in swallowing therapy?
Swallowing exercises strengthen and coordinate the muscles of the tongue, throat, and voice box. The SLP picks them based on what the evaluation shows. Common ones include:
Effortful swallow: swallowing hard, squeezing all the throat muscles.
Shaker exercise: lying on your back and lifting your head to look at your toes, which works muscles that help open the top of the esophagus.
Masako (tongue hold): swallowing while holding the tip of the tongue between the teeth. ASHA notes it is not right for everyone.
Mendelsohn maneuver: holding the voice box up for a few seconds in the middle of a swallow.
Tongue strengthening: pressing the tongue against a bulb or a tongue depressor.
EMST: blowing into a small device set to a resistance level.
Please do not start these on your own if you already cough or choke when you eat, because some exercises do not fit certain conditions.
SLPs also teach safer ways to eat right away, called compensatory strategies. Examples are tucking the chin down when swallowing, turning the head toward the stronger side, taking small sips, and swallowing twice. These help while you use them but do not build lasting strength. Electrical stimulation is offered in some clinics, but ASHA says its benefit is still unclear.
What are thickened liquids and IDDSI levels?
Thickened liquids move more slowly, which gives the throat more time to protect the airway. Many hospitals and SLPs describe food and drink textures with the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, which has levels from 0 to 7:
Drinks: Level 0 thin, Level 1 slightly thick, Level 2 mildly thick, Level 3 moderately thick, Level 4 extremely thick.
Foods: Level 3 liquidized, Level 4 pureed, Level 5 minced and moist, Level 6 soft and bite-sized, Level 7 regular or easy to chew.
Diet changes do not remove all risk, and thick liquids can lead some people to drink less and become dehydrated, according to ASHA. Some SLPs use a free water protocol, which allows plain water between meals when mouth care is good. Ask your SLP which plan fits you, and recheck it as swallowing improves.
How long does swallowing therapy take?
Most people need several weeks of therapy, but the length depends on the cause, how severe the problem is, and how much the person can practice. The Parkinson's trial above used a 4-week home program. After a stroke, much of the recovery happens in the first weeks and months, so early care matters. The 2019 AHA/ASA acute stroke guideline recommends a swallowing screen before a stroke patient eats, drinks, or takes medicine by mouth.
How can family members help at mealtimes?
Family members help most by following the SLP's plan at every meal and snack, not only during therapy visits.
Sit fully upright for meals and stay upright for about 30 minutes after.
Offer small bites and small sips, one at a time, at a slow pace.
Prepare food and drinks at the exact IDDSI level the SLP chose.
Brush teeth and clean the mouth at least twice a day. Mouth bacteria can cause pneumonia if they go into the lungs.
Tell the SLP or doctor about fever, a new cough, weight loss, or meals taking longer.
For a loved one with dementia, an occupational therapist (OT) can help with mealtime setup and routines. Our guide to occupational therapy for dementia explains how. In California, an OT needs advanced practice approval from the California Board of Occupational Therapy to work on swallowing itself.
Can I get swallowing therapy at home in Burbank?
Yes. Quad Therapy Inc. provides in-home speech therapy, including clinical swallow evaluations and swallowing therapy, in Burbank and nearby areas of Los Angeles County, including Glendale, Pasadena, North Hollywood, Studio City, and the San Fernando Valley. At home, the SLP sees your real meals, cups, chair, and routine, and family members can learn the plan in the same place they will use it.
If an instrumental exam is needed, we work with your physician to schedule a modified barium swallow study or FEES at a hospital or clinic. Swallowing problems after a stroke often come with aphasia, and our aphasia speech therapy guide covers that side of recovery.
Medicare Part B covers medically necessary speech-language pathology at home when a physician certifies the plan. The 2026 KX modifier threshold is $2,480 for PT and speech therapy combined, and it is not a hard cap. Our Medicare in-home therapy guide and our post on in-home therapy vs clinic explain the options.
Frequently asked questions
Can dysphagia go away?
Sometimes. Dysphagia from a stroke often improves over weeks to months, especially with therapy. Dysphagia from a condition that progresses, like Parkinson's disease or dementia, usually needs ongoing care to keep eating as safe as possible.
Is coughing while eating always dysphagia?
No. Everyone coughs on a crumb now and then. Coughing at most meals, or coughing with a wet voice, weight loss, or chest infections, is worth an evaluation.
Can an occupational therapist do swallowing therapy in California?
Only with advanced practice approval from the California Board of Occupational Therapy. Without that approval, swallowing evaluation and treatment are done by an SLP.
About Quad Therapy
Quad Therapy Inc. is a therapy company in Burbank, California, founded by a licensed physical therapist. We go to the patient. Our licensed therapists provide [SERVICES] in the home, and we staff clinics, schools, and facilities with qualified therapists. Every service is provided by a clinician licensed by the matching California board and stays within that board's scope of practice. To schedule a visit or ask about staffing, call (855) 313-3201 or visit quadtherapy.com. Our office is at 455 N Moss St, Suite 102, Burbank, CA 91502.
Next step: for the next 3 days, write down any coughing, choking, or wet voice you notice at meals, and which foods or drinks cause it. Then call us at (855) 313-3201 to schedule an in-home swallowing evaluation in Burbank, Glendale, Pasadena, or the San Fernando Valley.
This article is for education. It is not medical advice. Talk with a licensed clinician about your situation.
Sources
American Speech-Language-Hearing Association. Adult dysphagia (Practice Portal). asha.org
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756-2763. pubmed.ncbi.nlm.nih.gov
Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database of Systematic Reviews. 2018;10:CD000323. cochranelibrary.com
Baijens LWJ, Clave P, Cras P, et al. European Society for Swallowing Disorders and European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clinical Interventions in Aging. 2016;11:1403-1428. dovepress.com
Troche MS, Okun MS, Rosenbek JC, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912-1919. pmc.ncbi.nlm.nih.gov
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update. Stroke. 2019;50(12):e344-e418. doi.org
American Speech-Language-Hearing Association. Flexible endoscopic evaluation of swallowing (FEES). asha.org
International Dysphagia Diet Standardisation Initiative. The IDDSI framework. iddsi.org
Centers for Medicare and Medicaid Services. Therapy services: CY 2026 updates. cms.gov
California Business and Professions Code section 2530.2. leginfo.legislature.ca.gov