Dysphagia and Learning Disability

Question 1

What is a learning disability?

Answer 1

• A significantly reduced ability to understand new or complex information or to learn new skills.
• A reduced ability to cope independantely
• An impairment starting before adulthood, with a lasting effect on development.
• Typically an adult with an IQ of below 70 assessed by a psychiatrist/ psychologist.

Question 2

What are the 3 specific Acts or Legislation in Scotland?

Answer 2

1. Adults with Incapacity (Scotland) Act= most often impacts our work. Framework for safeguarding welfare and managing finances of adults who lack capacity.
2. Mental Health (care and treatment)= when and how adults can be treated, when they can be treated or taken to hospital against their will, what safeguards are in terms of their rights.
3. Adult Support and Protection (Scotland) Act= introduces measures to identify and protect adults at risk.

Question 3

What are two important legal checks to remember?

Answer 3

• Adult with Incapacity (AWI) section 47 Certificate= allows the doctor and other staff to give someone treatment they need.
• Welfare Guardian= People/ person appointed to make decisions on behalf of an adult who cannot make decisions themselves.

Question 4

What must we know prior to assessment in relation to Adults with Incapacity (AWI)?

Answer 4

• Does the person have capacity to consent to assessment?
• If not- have they been issued with a AWI certificate 47?
• Is there a welfare guardian in place?

A welfare guardian must be consulted for consent to treat a person prior to any SLT input.
If no welfare guardian- SLT will ask to see the AWI section certificate.

Question 5

What are the implications for dysphagia in this service model?

Answer 5

• Increased responsibility and challenge to coordinate and manage dysphagia setting- may need to coordinate MDT and risk management
• Linking in and support mainstream services such as acute or WestMARC.

Question 6

How do we make decisions/ what do we consider?

Answer 6

• Longevity of dysphagia with client group and potential for future deterioration.
• Best interests and managing risk

Question 7

What are the considerations for assessment?

Answer 7

• Medication
• Physical position
• Environment
  Behavioural Issues
• QOL
• Sensory Issues
• Equipment/ support
• Fatigue
• Oral hygiene
• Dietary needs

Question 8

Who is involved in MDT meetings to decide best interest?

Answer 8

Welfare guardian
Care provider
GP
Appropriate AHP's
Psychologist
Psychiatrist

Question 9

What are the differences between community LD and acute dysphagia?

Answer 9

• Length of involvement
• Person centred approach beyond traditional (assess, recommend, discharge)
• Working with a wide range of people as well as the individual themselves.
• Making compromises
• Balancing clinical presentation vs. ethics and QoL
• Upskilling families and staff- providing dysphagia awareness

Question 10

What are the differences between community LD and acute dysphagia?

Answer 10

• Length of involvement
• Person centred approach beyond traditional (assess, recommend, discharge)
• Working with a wide range of people as well as the individual themselves.
• Making compromises
• Balancing clinical presentation vs. ethics and QoL
• Upskilling families and staff- providing dysphagia awareness.

Question 11

What are some questions to consider for case studies?

Answer 11

• How is neuro functioning impacting on the swallow?
• What is the impact on normal anatomical structure for the person?
• How would you evidence consent?
• What quality of life factors should be considered?
• What ‘balance of risk’ and ‘best interests’ considerations are required?
• What are the least restrictive options?