Abstract

Dysphagia refers to the feeling of difficulty in passing food or liquid from the mouth to the stomach and requires rapid neuromuscular coordination not only of the esophagus but also structures in the oral cavity, pharynx, and larynx during a brief cessation of respiration. The swallowing mechanism can be separated into three stages: oral, pharyngeal, and esophageal. Disabilities resulting directly from dysphagia may arise secondary to aspiration, and the ongoing risk of aspiration has several consequences: limited oral intake of solid food and liquids, restriction of the diet (eg, to foods of a certain consistency), need for assistance when eating, and discomfort associated with eating. Evaluation usually includes assessment by a speech-language pathologist and often is supplemented by a modified barium swallow or a fiberoptic endoscopic evaluation of swallowing. The AMA Guides to the Evaluation of Permanent Impairment describes the process for evaluating impairment for dysphagia in Chapter 4, The Nervous System, Chapter 9, Ear, Nose, Throat, and Related Structures, and Chapter 10, The Digestive System. Section 9.3b, Mastication and Deglutition, includes information about the relationship of dietary restrictions to permanent impairment. Impairment for dysphagia is determined by considering the underlying cause for the dysphagia, dietary restrictions, feeding requirements, and complications.

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