What do you do when patients report severe swallowing difficulties, but all structural and neurological exams come back normal? In this episode, we talk to Prof. Anna Miles about her paper “Functional dysphagia: Developing a framework for assessment and treatment”. We explore why terms like “psychogenic dysphagia” or “phagophobia” are outdated, look into the neurobiological underpinnings of the condition, and discuss practical, biopsychosocial strategies for speech and language therapists.
Key Takeaways:
- Language Matters: Why shifting from psychogenic to functional dysphagia reduces stigma and improves patient care.
- The Biopsychosocial Framework: Moving away from a diagnosis of exclusion toward a positive, holistic assessment.
- Neurobiology & Agency: How functional dysphagia relates to a real disruption in the voluntary control of swallowing (loss of agency).
- Hypervigilance: How past negative events (e.g., a choking incident) lock patients into a restrictive cycle.
- Clinical Crossovers: Applying techniques from voice therapy (e.g., laryngeal massage) and laryngeal hypersensitivity management (cough/gag reflex) to functional cases.
- Psychoeducation: Why explaining the underlying mechanisms to the patient is a highly effective therapeutic tool in itself.
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