Rhea is an 80-year- old woman who lives alone. Her son was concerned about a rapid and noticeable weight loss and approached Rhea’s primary care physician with his concerns. A routine physical examination did not reveal anything that could be contributing to the loss of weight. During the doctor–patient interview following the physical examination, Rhea mentioned that she felt a frequent tightness in her throat and would sometimes gag when she was eating. Her son also told the physician that Rhea’s normally robust appetite had recently become significantly diminished and that she seemed unduly anxious during mealtime. Based on the negative results of the physical examination regarding the cause of Rhea’s weight loss and the information presented in the follow-up interview, her physician referred Rhea to the hospital for an evaluation for a potential swallowing disorder. The staff SLP in charge of swallowing disorders performed the initial portion of Rhea’s swallowing examination. Following a review of the case information, the SLP conducted an interview with Rhea and her son. The SLP noted that Rhea was alert during the interview and cognitively intact. During the oral- motor examination, the SLP evaluated head and body posture, the anatomy and general health of Rhea’s mouth, the function of her oral structures, and her ability to produce a strong cough. No problems were found in any of these areas. A modified barium swallow study (videofluoroscopy) showed an efficient swallow. Further testing with variegated textures of liquids and foods revealed that foods that were thick or sticky and hard to chew such as peanut butter or tough meats increased Rhea’s anxiety, often causing her to gag. Upon reviewing the swallow examination results, the swallowing team agreed that Rhea’s difficulty with swallowing was related to life circumstances. The team recommended that Rhea be provided with more opportunities to eat with others rather than alone. In addition, they recommended modifying her dietary intake, particularly reducing thick, tough, and chewy foods. By following the recommendations of the swallowing team, Rhea has begun to gain weight, and her family reports that she experiences less anxiety when eating. As you read this chapter think about: t )PX UIF DPOTJTUFODZ PG B GPPE NJHIU BGGFDU UIF person’s ability to swallow t )PX B TXBMMPXJOH EJTPSEFS NJHIU BGGFDU B person’s daily life t $POEJUJPOT PUIFS UIBO BHF UIBU NJHIU BEWFSTFMZ affect a person’s ability to swallow