- A client with a spinal cord injury and cervical spine hardware developed complex dysphagia requiring intensive swallowing rehabilitation.
- QLI used ENT evaluation, imaging, and stepwise therapy to address both structural and neurological barriers to swallowing function.
- Recovery focused on restoring independence and quality of life, progressing from tube feeding to independent eating and a return to shared social meals.
For a single swallow of food or water, more than 30 muscles and nerves must fire in precise coordination.
Swallowing is one of the most complex neuromuscular tasks the human body performs, and it happens dozens of times an hour without conscious effort.
But for people living with dysphagia — the medical term for a swallowing disorder — every bite and every sip becomes a calculated effort.
What Is Dysphagia?
Dysphagia is a swallowing disorder caused by a disruption in one or more phases of the swallowing process.
Those phases include the oral phase, when food is chewed and prepared in the mouth; the pharyngeal phase, when food moves through the throat while the airway is protected; and the esophageal phase, when food travels into the stomach.
“We commonly see it in our brain injury population or people with strokes, but with higher-level spinal cord injury, it can impact the respiratory system, which also plays a big role in swallowing,” said Zoey Bertsch, a speech-language pathologist (SLP). “Or there can be cervical spinal surgeries that might impact how the swallow is functioning, or even the anatomy of the pieces needed to swallow.”
Dysphagia can occur across a wide range of neurological and structural conditions, including stroke, multiple sclerosis, cerebral palsy, and neuromuscular disease.
The Part Nobody Talks About
Dysphagia rehabilitation often happens outside the spotlight. Part of that is because the process can be deeply personal and difficult to navigate.
Zoey said, “I think it’s a part of people’s journey that is a sensitive subject in general. Sometimes we have to modify diet textures. Maybe people have to eat a puree diet, and that’s something that is not fun for anybody. Or thickened liquids, maybe they can’t drink thin liquids right away. It doesn’t feel normal.”
For most people, food is tied to identity, family, and connection.
Zoey said. “Eating is such a social activity, and for a lot of our clients, that was something they really valued before, going out to dinner, or getting the whole family around the dinner table at holidays. I’ve found that it’s an important part of the recovery process and journey.”
A Case Study: When the Anatomy Works Against You
Jim Dillard’s case, a client in QLI’s spinal cord injury program, illustrates just how complex dysphagia can become, and how much is possible given the right team, the right tools, and the right plan.
Jim was in a motorcycle accident that resulted in a spinal cord injury and required cervical spinal surgery. Hardware was placed to correct the curvature of his spine.
His epiglottis, the cartilage flap that protects the airway during swallowing, could no longer fully invert.
“When food was coming down, it was kind of splashing off the backboard, per se, and headed right down towards his airway. He had to relearn how it felt to swallow again — to be able to still protect his airway and let food and drink go down the sides instead of hitting that backboard,” said Zoey.
Jim arrived at QLI with a gastrojejunostomy tube (GJ tube), a specialized medical device that helps deliver liquid nutrition, fluids, and medications directly into the digestive tract, used when swallowing isn’t safe yet.
His dysphagia was, as Trisha Funk, director of speech and life skills, describes, “complex and impacted by a lot of different things, ”including a compromised respiratory system and, in her words, “not a strong cough response.”
“Combing through the records, it just didn’t present like a typical dysphagia, or approach to dysphagia therapy, that we were used to,” Trisha recalled.
Trisha laughed as she remembered Jim’s goal from day one, “Jim told us coming in that he wanted to leave here eating, or Zoey and I were fired.”
The Clinical Approach: Collaboration and Creative Problem Solving
The first step was understanding exactly what was happening anatomically. Jim’s team referred him to a community Ear, Nose, and Throat specialist (ENT) for direct visualization of his laryngeal structures to determine what impairments were functional, what changes stemmed from surgery, and what could be related to aging and significant weight loss.
As Trisha explained, “When you lose a lot of weight, there’s not as much mass as there used to be, so your swallowing can feel different. You might not be able to propel the food or drink down as much as you could before.”
At that appointment, the team was also able to trial foods and liquids in real time, under direct observation.
“It helped us confirm that he had progressed enough to protect his airway in different ways. The food was finding its way down the right way. There was definitely some residue,” said Trisha. “We knew his swallow was weak, but we also knew it was time to graduate to more complex strategies.”
Purees were quickly introduced while texture was upgraded incrementally.
A subsequent esophagram gave the team further structural information and confirmation to continue expanding Jim’s diet.
Nursing, occupational therapy, and the broader care team were integrated throughout, particularly as Jim worked toward feeding himself independently, which carried its own therapeutic value by recruiting additional motor and cognitive pathways.
Throughout the process, one clinical reality had to be managed carefully: fear.
Jim had developed significant anxiety around eating and drinking, creating another barrier to recovery.
Before coming to QLI, Jim had been told that if he swallowed incorrectly, food or liquid could enter his lungs and cause aspiration pneumonia, a serious and potentially life-threatening infection.
That warning was accurate but delivered to someone who was already relearning how to swallow; it had become something heavier than a clinical caution.
It had become a reason not to try. The fear that was meant to keep him safe was now keeping him stuck.
Goal Setting as a Clinical Tool
Jim’s swallowing sessions were physically demanding, often uncomfortable, and slow. There were sessions where he didn’t want to be there.
His team learned early that motivation couldn’t be manufactured — it had to be anchored to something real.
For Jim, that something was dinner. Before his injury, taking people out — paying the bill, ordering the good wine, breaking bread with the people he cared about — was how he expressed love.
“We always say we don’t have a crystal ball. We don’t know where we’re going to get, but what can we shoot for? He always said, ‘Work hard during the day and then take people out at night, have good conversation and connect with others.’”
On the hard days, that goal was the anchor.
“When Jim would come to a session and say, ‘I don’t want to do this. It’s so much effort. It’s uncomfortable. I don’t like it. It doesn’t feel like it used to. It takes me forever to just get a couple bites down — we’d go back to that goal,” Zoey explained.
Progress, when it came, was celebrated in proportion to what it meant to Jim, not a standardized rubric. The day a team member made him a grilled cheese, Jim lit up.
Zoey said, “He was so excited. He said, ‘You think I can really try it?’ We got to do the grilled cheese, and he sent a picture to his family and was so excited to be able to eat something that sounded good to him again.”
Later: peas. A muffin from the pantry. Broccoli slaw. Each one was a genuine milestone, because eating for pleasure had returned.
From the Clinic to Kobe Steakhouse
The goal Jim had worked toward was never abstract. It was a restaurant reservation, a table, a menu, and the people he wanted to share it with.
“Jim rolls up to our session one day, and he’s like, ‘Hey, I’m planning to take the team out for hibachi,'” Zoey recounted. “It was exciting to see him start to drive his own progress and comfortability. He organized an outing for the entire team, made the reservation, and took us all out for hibachi to celebrate all the progress he’s made in his journey so far.”
The evening delivered exactly what Jim had been working toward.
“To see him in that environment […] his smile never left his face that entire night,” Zoey said. “He got to give a speech and talk about how meaningful it was for him to be able to break bread, as he’d say, and take people out again and socialize.”
For his QLI team, the moment was significant beyond sentiment. It marked a client who had moved from passive recipient of care to the driver of his own recovery — a transfer of agency that is, in many ways, the goal of all rehabilitation.
What Jim’s Journey Tells Us
Jim came to QLI with a feeding tube and a prognosis that didn’t leave much room for optimism. He left planning dinner reservations.
His journey shows that dysphagia, even in structurally complex cases, is not always permanent. Progress often depends on time, creativity, collaboration, and a client willing to keep showing up through difficult days.
“The prognosis you receive in the beginning isn’t always what will stand forever, and it can change over time,” Zoey said. “There’s still hope. There’s still progress that can be made if you put in the hard work.”
Jim’s case also highlights something clinicians know well, but documentation rarely captures that eating carries enormous social and emotional weight.
No single provider held the full picture. The ENT, speech-language pathology team, occupational therapy, nursing staff, and radiology each contributed a critical piece.
“We’re lucky to have our community partners,” Trisha said. The outcome reflected that. So does the lesson: when dysphagia is complex, the answer is rarely one clinician working harder. It’s more clinicians working together.
And sometimes, the milestone that matters most is the quietest one. Not the hibachi dinner, not the grilled cheese, but an ordinary afternoon when Jim reached for a tissue and blew his own nose without asking for help.
“It was like a full circle, almost,” Trisha said. “He’s been doing hand-to-mouth and meals independently for quite some time, and meds independently. But there was something about seeing him blow his own nose. I said that to him, ‘I think that was the first thing that I helped you with. You really don’t need us anymore.”
Now, Jim is home without a feeding tube, able to break bread with those around him and enjoy one of his favorite pastimes again.
Categories: Client Story, Rehabilitation, Spinal Cord Injury