A holistic journey: Caring for patients with dysphagia
There is a unique sense of fulfillment in watching someone rediscover the simple pleasure of eating—a warm bowl of homemade chicken noodle soup, a celebratory slice of birthday cake, or even a glass of ice-cold water. Most of us give little to no conscious thought to eating and swallowing, which is often an effortless part of life. But for people who have difficulty swallowing, dysphagia can significantly impact their lives, making every meal feel like a challenge.
Early in my doctoral studies at Huntington University in Indiana, I learned through countless hours of dissection in the cadaver lab that eating and swallowing is a complex action, involving the coordination of more than 30 nerves and muscles to safely transport food from the mouth to the stomach. I quickly realized the negative impact dysphagia can have on a person’s well-being and quality of life. I was eager to explore occupational therapy’s role in providing intervention with this population, which inspired me to apply to the Mayo Clinic Dysphagia Fellowship.
Mayo Clinic in Rochester, Minnesota, offers the only accredited 54-week occupational therapy Dysphagia Fellowship. This fellowship provided me with advanced practice skills in the clinical practice area of dysphagia. I was offered personalized guidance and focused attention, facilitating strong clinical practice skills and gaining confidence through encouragement and constructive feedback. I appreciated the extended time to learn about dysphagia academically and apply that knowledge in the clinical setting.
As a dysphagia-trained occupational therapist, I found that the focus extends beyond the anatomy and physiology of swallowing. The whole person is considered—their routines and rituals, cultural traditions, social connections, and aspirations (no pun intended). Swallowing therapy involves more than the act of swallowing; the patient’s physical and emotional well-being are a pivotal piece of the plan of care.
With a holistic lens, a dysphagia-trained occupational therapist may consider the following interventions:
- Adjustments in seating and positioning
- Adaptations/modifications of the environment for greater cognitive focus
- Instruction of patients in oral motor and swallow exercises for improved strength
- Creation of an upper-body home exercise program
- Implementation of an oral hygiene program
- Use of adaptive equipment for improved self-feeding abilities
- Consideration of diet modifications or compensatory techniques
- Participation in goals of care discussions
In addition, I was able to work closely with a multidisciplinary team including physicians, nurses, pharmacists, dieticians, physical therapists, and palliative care specialists. Each member of the multidisciplinary team provides a unique perspective, ensuring the diverse needs of the patient are met.
During my time in the fellowship, I experienced firsthand how profound this work can be. An impactful experience I had was the opportunity to work with a patient who was recovering from a stroke. The patient experienced dysphagia, which made swallowing liquids and solids difficult, affecting their overall nutrition and recovery. From the initial evaluation to the final treatment, it was incredible to track their progress and participate in small victories along the way. I vividly recall the final session, where I was able to participate in their birthday celebration alongside family and friends that included a slice of their favorite birthday cake and a cold glass of milk! Watching them eat and swallow their favorite foods without difficulty was a powerful reminder of why this practice matters.
Throughout my fellowship, I was not only able to grow as a clinician but I contributed to the current research and literature. With the exposure to complex cases, cutting-edge research, and best practices, I was able to utilize my knowledge and experiences to author a book alongside Wendy Avery, MS, OTR/L; Janelle Hatlevig, MA, OTR/L, BCPR; and Shari Bernard, OTD, OTR/L, SCFES, titled Adult Feeding, Eating, and Swallowing: Occupational Therapy Dysphagia Management, specifically focused on educating practitioners who work with adult patients who have dysphagia. Since the fellowship graduation in 2023, I’ve joined the Mayo Clinic acute care team, where I continue to work with patients with dysphagia and teach/mentor the upcoming cohorts of fellows.
I have realized that eating is more than nutrition—it’s a social connection and a celebration! I have discovered that dysphagia is multifaceted, requiring evaluation and treatment that are also multifaceted, dynamic, and diverse. Working with patients who have dysphagia has helped me realize how much I take for granted in just being able to have a cold glass of water and what a blessing that is!
Emily Rinaldi earned her doctorate degree in occupational therapy from Huntington University in May 2021. She is currently an acute care occupational therapist at Mayo Clinic in Minnesota and holds advanced training in the evaluation and treatment of dysphagia for the geriatric population across the acute care and outpatient settings.