Barium Swallow procedure - any advice please?

MIL had has a swallowing problem for a few months, which recurred over Christmas as she had 3 choking episodes when she was eating. She is totally chair bound by day, which doesn’t help her eating posture and probably adds to the problem. She also had surgery to fuse 2 neck vertebrae about 5 years ago, following a fall, so this may also affect her swallowing.

I raised her issues with her home care company and they offered to contact her GP as soon as the surgery opened in New Year, and ask for a SALT assessment. Out of the blue this morning, Mum gave us a letter from Hospital (20 miles away) with an appointment for a Barium swallow next Wednesday. They have totally missed the point that she is housebound and pretty immobile, so even getting her to the hospital without ambulance transport is impossible. They included a leaflet on how to book the hospital car volunteer service - she cannot get out of her chair without a hoist, never mind into a car! I will have to look into wheelchair transport options which she is happy to pay for, but of more concern is whether she is physically able to have the procedure.

I have read the info provided and it says she needs to get changed into a gown and be asked to move into various positions during the process. She cannot move unaided, it takes 2 carers and a full hoist to get her into her electric bed, her arms are very weak so she cannot help position herself and cannot stand at all. I can hopefully go with her to the appointment (Covid rules permitting), but I will struggle to help her undress.

I cannot speak to the hospital until Monday, but want to prepare myself with info to ask the right questions, as I think this will be beyond mum’s physical abilities. Can anyone with experience of this advise please? Thanks

Hi Witch Hazel,
some of the children I used to work with had swallowing/choking issues. They were usually seen by a speech therapist first and only referred for the barium swallow test if the speech therapist advised this as necessary. These children all had severe disabilities and the older ones would have needed hoisting and none of them would have had the understanding to co-operate; therefore the hospital should have the capability to cope with your MIL’s disabilities - however - I would definitely contact them as they won’t automatically be prepared for this and it’s a long journey to then be sent home again without the test being done as they weren’t prepared. The hospital should be able to arrange wheelchair transport too.


Thanks Melly, It does say on the leaflet that if you will have difficulty moving on the xray table, to give them a call, which I will do on Monday. She has had the letter for a week and only told us when she rang with her shopping list last night, so I could have phoned sooner. I have read a couple other guides online, which says they like to take some images standing or rolled on each side, which will not be possible.

She said she read the details and is sure she can do it all, as she always over estimates her abilities. She will also be very distressed on the day as she hates all the “extra fuss” everyone makes now, but I don’t want to waste the NHS’s time or mum’s expense in paying for the transport if it won’t work when we get there.

She had a visit from the local Speech Therapist when this all started about 6 months ago, and they assessed her, gave her some “exercises” to move her neck and facial muscles and suggested she makes sure she is sitting upright and takes frequent sips of water during a meal. We sat with her and had Christmas lunch, and she is slumped in the chair, eats too quickly and then panics and takes a huge gulp of water which makes the choking worse. I expected the Speech therapist to at least come back and re-assess/re-iterate their advice, but no one has been in contact at all. Mum is forgetful and muddled, and when we try to remind her of things, she gets snappy and says she already does them … we witnessed that she doesn’t :frowning:.

Thank you for your advice and I will definitely give them a call on Monday, then start trying to find some suitable transport for her.

Witch Hazel,
if she is choking on the water - she may need thickened drinks. It sounds like she needs to be seen again by a speech therapist. I would enquire when you ring about wheelchair transport too.

An OT might be able to improve her seating so she is in a better position to eat, worth a referral.

Also a smaller spoon might slow her down a bit.


Thanks Melly :slight_smile:

I don’t think its the water as such, as she drinks gallons of tea and never has an issue with that. I think she starts to choke and thinks the water will cure it, but instead of a few sips that the SLT recommended to help move things on, she gulps it down and makes it worse. Sometimes I think the action of “sipping” relaxes the spasm and also gives the person something else to concentrate on, so avoids the panic of the situation. A big gulp just adds to the irritation already brewing in her throat and makes things worse.

This is another reason I need to accompany her when anyone is assessing, as she just says everything is fine and that she does all that they suggest every time, when we know she doesn’t. She is so muddled, I think a mental capacity assessment is also on the cards … she rang last night to give her shopping list, then again this morning as she had forgotten she called us yesterday … :frowning: