[Dysphagia] diet modification question

[vwood at doh.health.nsw.gov.au (Vicky Wood)]

Hi 
I tend to partially disagree. In regards to mastication of bolus
patients may have the ability to prepare the bolus adequately due to a
normal oral phase. However, as a person becomes hungry or is consuming
food that her or she enjoys, protein receptors from the oral cavity are
sent to the hypothalamus to accelerate our intake.( Note: Once this
bolus reaches our stomach and duodenum it triggers these receptors that
signal the hypothalamus to induce satiety. This is how we don't overeat.
Prader-Willi Syndrome has a break down in this area)  This is called the
appetizer effect.
We don't see people increase rate of food to the mouth so how do we
accelerate our intake? We accomplish this by decreasing the oral prep
stage. Basically masticating the bolus less. 
Therefore despite the ability with the oral phase, the  phenomenon
"appetizer effect" may override this resulting in difficulty with
pharyngeal and esophageal motility etc.
Also, with working on a geriatric ward, I  often see very impulsive
patients that skip the oral prep stage all together however present in a
artificial, controlled environment like MBS assessment quite well.
Im sure there are plenty of other examples like this.
Imperative to look at the patient in a holistic way to determine if a
modified diet is suitable not just at the oral phase post MBS
assessment.


Vicky Wood
Speech Pathologist


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