Management Approaches

Question 0

What does modifying the food involve?

Answer 0

Looking at:

Viscosity

Volume

Temperature

Lubricity

Aesthetics

Question 1

What are the behavioural approaches to management?

Answer 1

Modifying:

The food

The feeding activity

The patient

The mechanism

The swallow

Question 2

What does modifying the feeding activity involve?

Answer 2

Thinking about:

Timing of meals - such as not eating when fatigued after physiotherapy

Lubricating the oropharynx with a sip of drink before eating

Supplying equipment such as non slip mats and adapted utensils to facilitate independent feeding

Oral hygiene after meals

Question 3

What does modifying the clients behaviour involve?

Answer 3

Prompting them to slow down their rate of self feeding

Using a chin down position when swallowing

Remaining upright for 30 minutes after a meal to prevent reflux

Question 4

What is direct therapy?

Answer 4

Logemann (1999): working directly on swallowing

Question 5

What direct therapy techniques are there?

Answer 5

Head turn

Supraglottic swallow

Question 6

What is indirect therapy?

Answer 6

Exercises to improve motor control without swallowing food or drink

May involve practising swallowing saliva

Question 7

When is indirect therapy commonly used?

Answer 7

When patients aspirate on all food and drink and are therefore unsafe for all oral intake

Logemann (1998) advises that it is not helpful to place a patient in a situation where he/she is aspirating with no hope of getting rid of material

Clients with a chest infection as it is harder to coordinate respiration and swallowing in these times

Question 8

What is an alternative to indirect therapy?

Answer 8

Advice to clients and carers only (Kennedy 1992)

Offered advice regarding positioning, modification of dietary consistencies and strategies to optimise the environment to facilitate safer eating and drinking

Question 9

When does Kennedy (1992) suggest advice is generally given?

Answer 9

When an active and aggressive approach is inappropriate:

Those in end stages of terminal or progressive illness

Those with significant cognitive deficits

Very frail elderly

Question 10

What are the management approaches available to SLTs?

Answer 10

1) compensatory approach: to reduce aspiration and residue to improve oral transit of for and fluid
Diet and fluid modification
Swallow postures and manoeuvres

2) rehabilitative approach: to improve motor skills to change swallow physiology
Facilitation techniques - e.g. therapy exercises, improving range and strength of movement

3) combination of approaches

Question 11

What options are there regarding medication in patients with dysphagia?

Answer 11

Syrup
Soluble
Crushed - but we need to be aware of the possible change in efficacy and the fact that this can produce a powder which may be inhaled by therapist
IV