1. Stevens, Monica E. MS, MA, CCC-SLP, CCC-A

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As a speech-language pathologist-audiologist, I need to respond to "Dysphagia: Going Down and Staying Down," by Toni J. Galvan (January).


Galvan's introduction presented a sufficient overview of swallowing disorders, but the chart entitled "Eating Positions for Specific Swallowing Dysfunctions" offers incorrect information, leaving the reader with a potential for drowning a patient with liquids or choking him with food. 1,2 Although Galvan offers important information on the significance of "silent aspiration," she doesn't note that the risk can be detected with fluoroscopy and a modified barium swallow test. This is the only way to rule out silent aspiration. 3,4


The article also makes recommendations for positioning with which I disagree. Side lying, while once used, is by no means acceptable today. Gravity assists the food to the stomach, but it's the 26 muscles and six cranial nerves that determine the effectiveness of a swallow. 1,2 It should also be noted that collaborative stroke-rehabilitation teams insist on a speech-language evaluation within 24 hours of admission.


In misinforming readers, this article disheartened me about the nature of nurses' educational backgrounds.


Monica E. Stevens, MS, MA, CCC-SLP, CCC-A




1. Logemann JA. Evaluation and treatment of swallowing disorders. San Diego (CA): College-Hill Press; 1983. [Context Link]


2. Domenech E, Kelly J. Swallowing disorders. Med Clin North Am 1999;83(1):97-113, ix. [Context Link]


3. Plant RL. Anatomy and physiology of swallowing in adults and geriatrics. Otolaryngol Clin North Am 1998; 31 (3):477-88. [Context Link]


4. McCullough GH, et al. Inter- and intrajudge reliability of a clinical examination of swallowing in adults. Dysphagia 2000; 15 (2):58-67. [Context Link]