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 

Cathy Basterfield
Owner Access Easy English
Consultant – Speech Pathologist

Telephone: 0466 579 855

Email: cathy@accesseasyenglish.com.au

Website: www.accesseasyenglish.com.au
Facebook: https://www.facebook.com/accesseasyenglish (our recent projects)
Blog: http://accesseasyenglish.blogspot.com.au (research and commentary)

How literate is our society?

There has been some discussion in tweets and blogs and at various conferences about literacy recently.

A range of researchers have talked about literacy from different perspectives. Each of these is important to gain a fuller understanding of what you need to consider for inclusion and participation for the people with whom you engage.

There was a discussion on RadioNational this week about the PIAAC, 2013 data which tells us 44% of the Australian adult population has non functional literacy. Listen to the broadcast to hear about 2 individuals’ issues and needs when they had non functional literacy.

Easy English is needed as part of a broad plan to engage with adults of all backgrounds so they can be included, participate and make meaningful decisions about their own lives. This may be for medical information, housing or organising a new mobile phone contract and many other things. Some examples of Easy English are here. Think about what documents you need in Easy English, and ask me how to make this happen.

Today I read about The World’s Most Literate Nations data.

This is an interesting analysis and worthy of discussion. It does address the issues about what constitutes literacy and evidence of literacy in a community. The report does agree the aspects reviewed could impact on the results. However, for this review the researchers used 

 - access to a computer (Percentage of households with either desktop or laptop computer and excludes other devices such as cell phone, personal digital assistant, or T);

- input to education (compulsory yrs of schooling and amount spent per student related to GDP);

- output of education (Data from PIRLS (Progress in International Reading Literacy Study) literacy, data from PISA (Programme for International Student Assessment) and data from  YOA for 15-18yr olds);

- Libraries (Number of academic libraries, public libraries, school libraries, volumes in all (only) public libraries);

- Newspapers (including: paid-for dailies, circulation, online editions, export of newspapers) 

More details about each of these areas is in the research report. What other areas do you think need to be considered when you wonder whether Australia is a literate nation?

On the data analysed where does Australia fit in the overall schema of being a literate nation?

Where would you expect them to be?

Australia is not in the top 10 overall. Nor is it in the top 10 on any 1 of the parameters analysed. 

Australia is 16th overall according to this data. Have a look at the countries above and below Australia. Would you expect this is where our literacy is, as a country? If you agree, this is accurate, what do we need to do to develop into a more literate society?  What resources, what research, what support needs to be in place? What infrastructure, what training, what else needs to be done. I would be interested to hear your thoughts.

Cathy

Cathy Basterfield

Access Easy English

Consultant – Speech Pathologist
Telephone: 0466 579 855
Email: cathy@accesseasyenglish.com.au

Website: www.accesseasyenglish.com.au
Facebook: https://www.facebook.com/accesseasyenglish (our recent projects)

Twitter: @accesseasyengli