Complex Swallowing Clinic
Specialist assessment and rehabilitation for people with complex swallowing difficulties
When swallowing difficulties continue despite previous assessment or treatment, it can be difficult to know what to do next.
You may be wondering:
- Why is swallowing still unsafe?
- Why has progress stalled?
- Are there other treatment options?
- Would another specialist opinion help?
- How do we bring everyone together?
Our Complex Swallowing Clinic provides specialist Speech and Language Therapy assessment, mobile instrumental swallowing assessment and personalised rehabilitation for people with complex dysphagia (swallowing difficulties).
For more complex situations, we can also coordinate multidisciplinary review, bringing together the right clinicians to develop a shared understanding of the difficulties and a coordinated rehabilitation plan. Our aim is simple: to understand why swallowing has changed, identify the treatments most likely to help, and support people to achieve the safest and most meaningful return to eating, drinking and everyday life.
Looking Beyond the Swallow
Swallowing is one of the most complex functions performed by the human body. It depends on the brain, nerves, muscles, breathing, sensation, posture, cognition and nutrition working together.
When something changes, there is rarely a single explanation.
While many people benefit from a standard swallowing assessment, others continue to experience difficulties despite previous investigations or treatment. Progress may plateau, different professionals may have different perspectives, or important questions may remain unanswered.
Our clinic has been developed for these more complex situations.
Rather than focusing solely on swallowing, we consider the whole person – their health, goals, rehabilitation potential, environment and quality of life – to develop an assessment and rehabilitation plan that is both clinically appropriate and meaningful to them.
How We Can Help
Depending on your needs, our service may include:
- Comprehensive Speech and Language Therapy assessment
- Mobile FEES (Fibreoptic Endoscopic Evaluation of Swallowing), where clinically appropriate
- Review of previous investigations and clinical information
- Observation during mealtimes within the person's usual environment
- Collaborative multidisciplinary review for complex cases
- Personalised swallowing rehabilitation
- Education and training for families, carers and professionals
- Support with Eating and Drinking with Acknowledged Risks (EDAR)
Every recommendation is tailored to the individual and based on current clinical evidence, specialist assessment and what matters most to the person.
Collaborative Specialist Care
Some people benefit from input from more than one specialist.
Where appropriate, we coordinate multidisciplinary review with experienced clinicians, helping everyone develop a shared understanding of the swallowing difficulties and agree a coordinated rehabilitation plan.
Depending on the individual's needs, this may include collaboration with specialists in rehabilitation medicine, ENT, dietetics, respiratory care or neurological rehabilitation.
Our aim is to ensure that everyone involved is working towards the same goals with a clear, practical plan.
What to Expect
Step 1 – Initial Consultation
Every referral begins with a specialist Speech and Language Therapy consultation, either in person or online.
We'll take time to understand what has happened so far, discuss current concerns, review previous assessments and treatment, and identify what the individual hopes to achieve.
Following this discussion, we'll recommend the most appropriate next steps.
Step 2 – Specialist Assessment
Assessment is tailored to each individual and may include:
- Clinical swallowing assessment
- Mobile FEES
- Review of previous investigations
- Mealtime observation
- Oral care review
- Communication and cognitive assessment where appropriate
- Environmental assessment
- Liaison with the wider clinical team
Our focus is not simply on identifying that swallowing is impaired, but on understanding why.
Step 3 – Personalised Rehabilitation
Every rehabilitation programme is individualised and may include:
- Targeted swallowing rehabilitation
- Behavioural and environmental strategies
- Expiratory Muscle Strength Training (EMST)
- McNeill Dysphagia Therapy Programme (MDTP)
- Phagenyx®
- Oral care optimisation
- Education and training for families, carers and support teams
Treatment is reviewed regularly and adapted as recovery progresses.
Step 4 – Multidisciplinary Review
For particularly complex presentations, we can coordinate multidisciplinary review to bring together the professionals best placed to support the individual.
Following discussion, recommendations and treatment options are shared clearly, ensuring everyone understands the agreed plan and next steps.
Mobile FEES
Where clinically appropriate, we provide mobile Fibreoptic Endoscopic Evaluation of Swallowing (FEES) with our ENT Colleagues.
By carrying out FEES in the person's usual environment, we can often gain valuable insights into swallowing during everyday activities. This allows us to assess how different food and drink consistencies, strategies and rehabilitation techniques influence swallowing and helps us develop more personalised recommendations.
Eating and Drinking with Acknowledged Risks (EDAR)
When appropriate, we support individuals, families and professionals through the Eating and Drinking with Acknowledged Risks (EDAR) decision-making process.
These can be some of the most challenging conversations in healthcare.
Our role is to ensure decisions are informed, collaborative and person-centred, balancing clinical safety with quality of life, dignity and individual choice.
Who We Support
We support people experiencing swallowing difficulties following:
- Stroke
- Acquired brain injury
- Traumatic brain injury
- Progressive neurological conditions
- Prolonged ventilation or critical illness
- Tracheostomy
- Complex respiratory conditions
- Other neurological or medical conditions affecting swallowing
We also provide second opinions where swallowing rehabilitation has plateaued or further specialist assessment would be beneficial.
Referrals
We welcome referrals from:
- Individuals and families
- Consultants
- GPs
- Case Managers
- Speech and Language Therapists
- Rehabilitation teams
- Care providers
- Solicitors and Deputies
- Insurers
If you're unsure whether this service is the right fit, we're always happy to discuss a case before referral.
Our Approach
Eating and drinking are about much more than nutrition. They're about independence, confidence, connection, values and quality of life.
Everything we do starts with understanding the individual, not simply the diagnosis.
By combining specialist assessment, collaborative clinical reasoning and personalised rehabilitation, we help people achieve the safest and most meaningful outcomes possible.
Discuss a complex swallowing case.
If you're unsure whether this service is the right fit, we're always happy to discuss a case before referral.