Thursday, 12 May 2016

Swallow Awareness Day 2016

Yesterday was #900Swallow Awareness Day across many countries.

Graphic Courtesy of Speech Pathology Australia

As Speech Pathologists, swallowing management or dysphagia management crosses many diagnosis’s.

Here are just some of the thoughts and prompts from various people in the last 24 hrs.

     Working with people with complex communication needs, it often is a lifelong issue;
     For parents of children, issues of nurturing, and feelings of failure need to be considered when their child has swallowing challenges;
     Adults need information about risks and rewards to have self determination about what they think are the risks and rewards for having certain food types, or not;
     Substituted nutrition or enteral nutrition is important for some people (sometimes we call them (G-tube);
     We need to make sure people who have their nutrition by non oral means are still included in the social aspects of eating, morning tea outings and mealtimes;
     Lots of memories are associated with mealtimes and swallowing;
     There are some great hints about managing swallowing from the NSW CID guest Blogger A/Prof Bronwyn Hemsley. There are 3 blogs from A/Prof Hemsley this week;
     Aspiration pneumonia and silent aspiration can be a risk when you have compromised swallowing;
     Changes happen with our swallow, our enjoyment of food as we age, and also when we have medical conditions that deteriorate;
     Head and Neck surgery, stroke and Parkinson’s Disease can all have an effect on swallowing skills.

There is more discussion and ideas on Twitter. Follow #900swallows.
With little children we often talk about feeding, eg: I am breast feeding my baby; I am bottle feeding my baby.
As people with lifelong swallowing issues grow up, and have difficulties with their swallow, we refer to it as Mealtime Assistance.

Speech Pathologists can assist at all stages of life with swallow management from NICU babies, to the elderly.
How often does a NICU baby have oral sensitivity? Why? Think about all the tubes and touching that is "done to“ a medically unwell baby?  
An elderly person or resident in a nursing home may have different issues with muscle control or taste.

Speech Pathologists have lots of questions when they consider your swallow. Here are just a few of them:
-     different food textures - how many different food textures did you try yesterday?
-     different drink textures - what difference does milk versus a soft drink have for your swallow?
-     do you get good seal of your lips, with spoon/fork in your mouth, during chewing or the actual swallow?
-     can you control the food in your mouth; is there any seepage - via your mouth or down the back of your throat?
-     can you masticate (or chew) the food into a manageable bolus (clump of food) in preparation for your swallow?
-     what happens as you swallow - with all your different mouth structures? Are they coordinated? Do you clear your mouth when you swallow? Is there aspiration (it goes down the wrong way) of some or all of the food? Is there silent aspiration (there is no cough or other marker for us to see food has gone down the wrong way)
-     what happens over a couple of swallows?
-     do you tire easily?
-     can you eat enough for your nutritional and health needs?
-     what is your swallow like when you get sick, or are not quite sick but are feeling like you are a bit “under the weather”?
-     what is your swallow like when you are tired?
-     can you manage meals better in the morning? Would it be better to have non oral food (g-tube) for a later meal?

Swallowing management can include a whole range of different professions. Eg
•   Nutritionists - for health and growth;
•   Pharmacists - to manage medicines in the right way. Some tablets can be crushed, others  can't. Some can be in liquid form, others are not; 
•   Occupational therapists - for fork and spoon and knife control;
•   Physiotherapists for safe positioning and specialist setting for meals;

Some people have specialists positions they need for safe mealtimes. OT's and Physios work together with Speech Pathologists for the best outcome for the person.

And across all this is you and your family who may need to assist you with your meal. You may become adept at recognising when a food is a risk worth taking, or when something is not.

Late addition - but so important for social inclusion and participation. A Dysphagia Policy in a Restaurant in the UK. Area that needs significant work. How will the NDIS support this type of work?

I am happy to talk to you about Mealtime Assistance or training for staff or family about safety at Mealtimes.

Cathy Basterfield
Owner Access Easy English
Consultant – Speech Pathologist
Telephone: 0466 579 855
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