Just a couple of quick questions: Do you know why she is rinsing and spitting so often? Is it to alleviate a feeling of choking? Or dryness? Or maybe she thinks constant attempts will get her swallow back? Even people with a compulsion to do something, do it for a reason that is important to them. With that knowledge, maybe you can skip the unconcerned doctor and dietician (and shame on them) and go straight to the speech pathologist. Also it might be worth actually counting how many times an hour she does it. This will carry more weight with the healthcare workers if you can quantify it rather than telling them she does it constantly. It is possible the doctors think you are exaggerating or they are translating what you are telling them into once or twice an hour (hence their lack of concern). How long does she sleep before the need to rinse and spit wakes her up?