Speech and language therapy · London
Dysphagia (swallowing) therapy - London.
Specialist private SLT for adults with swallowing difficulty after stroke, head-and-neck cancer or neurological disease. Bedside evaluation, VFSS or FEES where indicated, and a structured rehabilitation programme with family training.
Why patients choose us
- 01
A specialist SLT with a dysphagia caseload
Not a generalist speech and language therapist. A named specialist SLT with a real dysphagia caseload across stroke, head-and-neck cancer and neurology.
- 02
Instrumental assessment where it matters
VFSS or FEES when the bedside picture is unclear. Silent aspiration is missed on clinical exam alone in up to a third of patients.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private dysphagia therapy costs in London.
Indicative ranges across our London SLT network. Tell us the diagnosis and we quote a firm figure across two or three options.
In short
A full 8-16 session rehabilitation programme in London: £1,400-£3,500, over 8-16 weeks.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial bedside swallow assessment with specialist SLT | £180-£320 | 60 min | Same visit |
| Follow-up therapy session (45-60 min) | £150-£280 | 45-60 min | Same visit |
| Videofluoroscopic swallow study (VFSS) | £220-£450 | 30-45 min | 48 hours |
| Fibreoptic endoscopic evaluation of swallowing (FEES) | £280-£550 | 30-45 min | Same visit |
| Typical 8-16 session rehabilitation programme | £1,400-£3,500 | 8-16 wks | Ongoing |
| Second-opinion review of prior SLT reports and imaging | £220-£420 | 30 min | 48 hours |
Prices vary by clinic, by the SLT, and by whether an instrumental study (VFSS in radiology, or FEES at the bedside) is needed. Home visits carry a travel supplement. We come back with a firm quote within one working day.
What dysphagia is
Difficulty swallowing, at any of three stages.
Dysphagia is difficulty moving food, drink or saliva from mouth to stomach safely. It can fail at the oral, pharyngeal or oesophageal stage - each with a different fix.
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How it presents
Choking or coughing when eating or drinking, food sticking, gurgly voice after swallowing, weight loss, recurrent chest infections, a wet or breathy voice, or a sensation of a lump.
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Not the same as pain
Painful swallowing (odynophagia) is a separate symptom, usually infective, inflammatory or malignant. It sometimes coexists with dysphagia but needs its own workup.
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Three stages, three fixes
Oral (chewing, bolus control), pharyngeal (swallow trigger, airway protection) and oesophageal (peristalsis, sphincter opening). The therapy differs at each level.
The journey
From referral to rehabilitation - what happens, in order.
One team from the first message to the last review - concierge SLT arrangement, assessment, therapy programme and follow-up.
Phase 1 · Before your assessment
Concierge, off-stage for you
Phase 2 · On the day
A morning at the clinic or at home
Phase 3 · After
Rehabilitation, weeks to months
- 01
Before
You send us the referral
A short, confidential form. Diagnosis (stroke, head-and-neck cancer, Parkinson's, MND, dementia), symptoms, prior imaging and any modified diet already in place.
- 02
Before
We come back with a recommendation
Within one working day: which SLT, whether a VFSS or FEES is worth booking first, and an indicative programme cost. An honest read either way.
- 03
Before
We arrange the assessment
Usually within one to two weeks. A clinical bedside evaluation to start, and an instrumental study booked in parallel if the clinical picture warrants it.
- 04
On the day
Bedside evaluation with the SLT
45 to 60 minutes. Oral motor exam, cranial nerve screen, cervical auscultation, cough reflex and a graded water swallow test with different consistencies.
- 05
On the day
VFSS or FEES if indicated
A videofluoroscopy under fluoroscopy with barium, or a fibreoptic endoscopic evaluation of swallowing at the bedside. Both directly visualise aspiration.
- 06
On the day
Therapy plan and home programme
A written plan: exercises, postural strategies, IDDSI texture level, family training and red flags. Sent to you and to your consultant the same day.
- 07
After
Rehabilitation and review
Weekly or fortnightly SLT sessions over 8-16 weeks. Reassessment at 4-6 weeks to progress the programme and reduce restrictions where safe.
Typical end-to-end: 1-2 weeks to assessment. Rehabilitation: 8-16 weeks. Review: every 4-6 weeks.
Common causes
Who benefits from specialist dysphagia therapy.
Neurological disease, head-and-neck cancer, oesophageal disease and age-related change are the commonest reasons for a referral. Medication side effect and myasthenia gravis also feature.
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Post-stroke dysphagia
Up to half of acute stroke patients aspirate. Early SLT input and a targeted exercise programme protects the lungs and preserves nutrition.
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Head and neck cancer, during and after
Radiotherapy and surgery to the pharynx, larynx or tongue base cause xerostomia, fibrosis and pharyngeal weakness. Prophylactic exercises help.
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Parkinson's disease
Reduced tongue base retraction, delayed swallow trigger and silent aspiration. Expiratory muscle strength training and LSVT-informed work help.
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Motor neurone disease (MND)
Progressive bulbar weakness. SLT focuses on safe strategies, texture modification and timely discussion about supplementary feeding.
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Dementia-related feeding difficulty
Distraction, oral holding and refusal. SLT input on positioning, pacing, spoon size, texture and carer training reduces distress and aspiration.
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Oesophageal stricture or reflux (GORD)
Food sticking in the chest, regurgitation, coughing at night. Needs gastroenterology input alongside SLT postural and texture work.
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Presbyphagia in the older adult
Age-related weakening of the swallowing muscles without a discrete lesion. Responsive to targeted strength and coordination work.
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Red flag: recurrent chest infections
Repeated aspiration pneumonia, unexplained weight loss or a first choking episode needs urgent assessment - not a slow private wait.
Assessment
Clinical bedside evaluation, plus VFSS or FEES.
A good assessment starts clinical and adds instrumental where the answer is not obvious. Both VFSS and FEES directly visualise aspiration - the clinical exam alone cannot.
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Clinical bedside swallow evaluation
A specialist SLT reviews cranial nerve function, oral motor strength, laryngeal elevation, cervical auscultation, cough reflex and a graded water swallow test with different consistencies.
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Videofluoroscopic swallow study (VFSS)
In a radiology department. Barium-coated boluses are swallowed under fluoroscopy, giving a moving picture of the oral, pharyngeal and upper oesophageal stages.
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Fibreoptic endoscopic evaluation of swallowing (FEES)
At the bedside or in clinic. A flexible nasendoscope views the pharynx directly during swallowing. Shows secretions, penetration and aspiration in real time.
Therapy components
The building blocks of a rehabilitation programme.
Exercises to strengthen and coordinate the swallow, postural strategies to protect the airway, texture modification to buy safe intake, and adjuncts like NMES and expiratory muscle strength training.
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Oral motor and pharyngeal exercises
Mendelsohn manoeuvre, Shaker (head-lift) exercise, effortful swallow, supraglottic and super-supraglottic swallow, tongue-hold (Masako) and jaw-opening resistance.
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Postural strategies
Chin tuck, head turn to the weak side, and head tilt to the strong side. Simple, low-cost adjustments that reroute the bolus and protect the airway.
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Texture modification (IDDSI)
Standardised IDDSI levels 0-7 for fluids and food, from thin liquid to regular. Directed by SLT, with a dietitian to keep nutrition and hydration adequate.
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Neuromuscular electrical stimulation
VitalStim and similar surface NMES devices, with electrodes over the anterior neck. Adjunct to conventional therapy in selected patients; evidence mixed but growing.
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Expiratory muscle strength training
EMST150 threshold device to strengthen the muscles that generate an effective cough. Good evidence in Parkinson's disease and post-stroke populations.
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McNeill dysphagia therapy programme
A systematic, exercise-based rehabilitation programme that progresses through hierarchical bolus challenges. Used in head-and-neck cancer and neurological cases.
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Biofeedback and surface EMG
Real-time visual feedback of swallow effort. Helps patients learn effortful swallow and Mendelsohn manoeuvre correctly, particularly in the early rehabilitation phase.
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Second-opinion review
A specialist review of your SLT reports, VFSS or FEES footage and current programme. Sometimes the answer is different exercises, not more sessions.
Texture modification and IDDSI
IDDSI levels 0-7, directed by SLT and dietitian.
The International Dysphagia Diet Standardisation Initiative gives a global, unambiguous set of consistency levels. Thickened fluids reduce aspiration risk but under-eating and dehydration are real - a dietitian works alongside the SLT to keep nutrition adequate.
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IDDSI Level 0-4
Fluids
Level 0 thin, 1 slightly thick, 2 mildly thick, 3 moderately thick, 4 extremely thick. SLT-graded to the specific swallow.
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IDDSI Level 3-4
Liquidised and pureed
Overlapping food and fluid tiers. Smooth, cohesive, no lumps. Nutritionally fortified to prevent under-eating.
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IDDSI Level 5-6
Minced, moist and soft
Small lumps, moist, requires basic chewing. A common step in progressive rehabilitation off pureed diets.
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IDDSI Level 7
Regular and easy to chew
Normal food, or an easy-to-chew variant. The goal for most patients recovering from post-stroke dysphagia.
Head and neck cancer rehabilitation
Prophylactic, during, and long after treatment.
SLT input across the whole head-and-neck cancer journey preserves function - from prehabilitation to lifelong late-effect surveillance.
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Before treatment (prehabilitation)
Prophylactic exercises started before radiotherapy or surgery preserve pharyngeal muscle bulk and range of movement. Baseline swallow measurements let us track change.
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During and immediately after
Management of xerostomia, mucositis and acute pharyngeal oedema. Postural strategies and consistency modification to keep oral intake going and avoid a feeding tube where possible.
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Long-term surveillance
Late radiation fibrosis can cause new or worsening dysphagia years later. Periodic SLT review and a lifelong home programme reduce late deterioration.
Where in London
Our small panel of London dysphagia SLTs.
Independent London SLTs and hospital-based private services with a real dysphagia caseload. Introductions are made privately, once we understand your case.
London clinics we work with
Central London and beyond, home visits included.
- Voice Care Centre (Harley Street)
- London Speech and Voice Clinic
- HCA The Wellington Hospital SLT
- University College London Hospital, Private SLT
- Royal Marsden Private, Head and Neck SLT
- National Hospital for Neurology, Queen Square, Private
- Care Voice Therapy
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Specialist dysphagia SLTs with high caseloads in stroke, head-and-neck cancer or neurology
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Access to VFSS in a radiology department and FEES at the bedside, not one or the other
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Working relationships with ENT, gastroenterology, neurology and dietetics for joint decisions
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Home-visiting SLTs for patients who cannot safely travel, across Greater London
Safety and home programme
What to expect - honestly.
A good dysphagia programme is 90% what you do at home. Exercises two to three times daily, family training, mouth care and review every 4-6 weeks to progress.
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Silent aspiration is common
Up to a third of aspiration episodes happen without a cough. A clinical bedside test alone misses them. VFSS or FEES is the safety net when the picture is unclear.
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Thickened fluids are not risk-free
They reduce aspiration but worsen dehydration and are often refused. IDDSI-graded, and reviewed regularly, not a permanent life sentence unless truly needed.
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Aspiration pneumonia risk
Poor oral hygiene multiplies the risk of pneumonia if aspiration occurs. Twice-daily mouth care with a soft brush is a core part of the therapy plan.
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Nutrition and hydration
Texture-modified diets are often under-eaten. A dietitian works alongside the SLT to keep calorie, protein and fluid intake adequate, with fortification if needed.
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Family and carer training
A one-off session for the person feeding you at home: pacing, spoon size, texture, positioning, mouth care and the red flags that mean stop and call.
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Progression, not just protection
Good rehabilitation reduces restrictions over time. Reassessment every 4-6 weeks to widen the diet where safe, not to leave you on Level 4 forever.
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Head and neck cancer, long-term
Late radiation fibrosis can cause dysphagia deterioration years after treatment. Lifelong swallow hygiene and periodic SLT review is worth building in.
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When to consider gastrostomy
For progressive conditions or severe post-treatment dysphagia, a PEG or RIG tube is a supplement, not a defeat. Discussed early and jointly with the medical team.
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Red flags after discharge
A new choking episode, fever with a productive cough, sudden weight loss, or a swallow that suddenly feels worse - call the SLT or your GP the same day.
Reading your SLT report
Your SLT report in four parts. Read the last one first.
Whichever clinic did the work, the report tends to keep to the same shape.
A quiet reminder
SLT language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 Header
Diagnosis, presentation and referral question
Underlying diagnosis, dysphagia symptoms, current diet and fluid consistency, prior imaging and the question the referrer wanted answered.
- 02 Assessment
Bedside findings and instrumental study
Cranial nerve exam, oral stage, laryngeal elevation, cough reflex, water swallow test outcomes and the VFSS or FEES findings if performed.
- 03 Findings
Aspiration, penetration and safe consistencies
Where the swallow is failing (oral, pharyngeal, oesophageal), penetration-aspiration scale score, and which consistencies are safe on the day.
- 04 Impression
Therapy plan and IDDSI recommendation
Read this first: exercises, postural strategies, IDDSI level for food and fluids, family training, review interval and red flags.
Recognised by major UK insurers
Cover for SLT dysphagia therapy varies by insurer and by indication - usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about dysphagia therapy.
Quick answers on thickened fluids, insurance, family training, paediatrics, VFSS vs FEES, and recovery time.
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Will I be on thickened fluids forever?
Not usually. Thickened fluids are a temporary safety measure while the swallow rehabilitates. Most patients with post-stroke dysphagia progress off them within weeks to a few months. In progressive conditions (MND, advanced Parkinson's), thickened fluids may become a long-term part of the plan, but they are still reviewed regularly.
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Will private medical insurance cover dysphagia therapy?
Most major UK insurers (Bupa, AXA, Vitality, Aviva, WPA, Cigna) fund SLT when medically indicated, particularly after stroke, head-and-neck cancer surgery or radiotherapy. Session numbers and instrumental studies are usually approved case-by-case. We confirm cover with your insurer before booking.
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Can my family help with therapy at home?
Family and carer training is a core part of good dysphagia rehabilitation. The SLT will train the person who feeds or supports you on positioning, pacing, spoon size, texture, mouth care and the red flags that mean stop and seek help. Home exercises are done two to three times daily, not just in clinic.
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Do you see children with feeding difficulty?
Paediatric feeding and dysphagia is a specialist subfield with its own SLTs and multidisciplinary pathways (usually including a paediatric dietitian, gastroenterologist and psychologist). We can arrange this too - see our paediatric feeding therapy page for detail.
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VFSS or FEES - which is better?
Neither is universally better. VFSS gives a full view of the oral, pharyngeal and upper oesophageal stages under fluoroscopy with barium, and quantifies aspiration well. FEES uses a nasendoscope at the bedside, does not need radiology, tolerates repeat testing and shows pharyngeal secretions directly. Choice depends on the question and access.
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How long is recovery from post-stroke dysphagia?
Most post-stroke dysphagia improves substantially in the first 4-12 weeks, with continued gains over 6-12 months. About 10-15% of patients have persistent problems at six months. Early SLT input, an active exercise programme and good oral hygiene make a measurable difference to outcomes.
Related treatments and conditions
Looking for something else?
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Voice feminisation therapy
Specialist SLT for voice pitch and resonance change.
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Stammering therapy (adult)
Fluency and confidence work for adults who stammer.
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Aphasia rehabilitation
Language rehabilitation after stroke or brain injury.
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Paediatric feeding therapy
Feeding and swallowing support for infants and children.
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Stroke recovery
Multidisciplinary rehabilitation after stroke.
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Gastroscopy
Upper GI endoscopy to investigate oesophageal causes.
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Oesophagectomy
Surgical removal of the oesophagus for cancer or severe disease.
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Send Enquiry
Tell us the diagnosis and we come back within a working day.
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Ready when you are
Book a private dysphagia assessment in London.
Tell us the diagnosis and symptoms. We come back within one working day with a named specialist SLT, a plan for VFSS or FEES if needed, and a firm quote across two or three options.