[Dysphagia] bolus size and choking

[Marie.Isbell at state.tn.us (Marie Isbell)]

I work with this population also.  We look at this in two ways.  1) size of the bite, which we assess through clinical observation and staff interview, and 2) diet textures, which would be the size of the piecesof food.  #2 is dependent on the person's ability to adequate process the food.  We use puree (smooth and creamy with no lumps), ground (1/8 to 1/4" sized pieces), diced (1/4 to ?" sized pieces), regular cut up (1/2 to 1" sized pieces) and regular (food is not processed for the person).  #1 is assessed based on the person's ability to form a bolus and initiate the swallow.  Since we primarily have direct care staff assisting at mealtime, we select a spoon by its bowl size.  If we want the person to have a smaller bolus, we'll use a youth spoon.  If no restrictions, a teaspoon.  And we never use soup spoons or tablespoons as they can hold more than would be safe.  Hope this helps.  Marie
 
Marie M. Isbell, MA, CCC-SLP
West TN Regional PNM Team
West TN Regional Office
8383 Wolf Lake Drive
Bartlett, TN 38133
(901) 213-1847
Fax: (901) 372-3460
Marie.Isbell@state.tn.us
 
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>>> Sandi Lancaster <swlslp@yahoo.com> 1/18/2005 6:20:52 AM >>>

Hello all,

Does anyone know of general recommendations for bolus
size for solids that will not obstruct the airway in
the average adult if a bolus were to be aspirated?

I evaluated a man who is profoundly MR and the
residential staff wanted recommendations from me on
bolus size.  He does not have a history of choking or
pneumonia, but his oral stage is marked by lots of
mashing of boluses against his palate rather than
mastication, and holding of boluses before initiating
a swallow.  He had no s/s of distress with any
consistency during my evaluation.  Because this
patient presents with good tolerance of all
consistencies with his current swallowing pattern, and
doesn't have a history of choking when fed by staff, I
don't really want to recommend diet modification (why
fix what isn't broken, right?)  But the current
"action plan" for this patient is for his food to be
cut into 1/2 tsp bites.  (Which I don't think is being
done anyway.)  I would like to have staff increase
their guideline for bite size as I think 1/2 tsp is
too tiny, but I really don't know of any general rules
for what bolus sizes will or will not obstruct the
airway during an aspiration event for an adult.  

I appreciate any feedback!

Thanks,

Sandi

=====
Sandi Lancaster, M.A. CCC-SLP
Speech-Language Pathologist


        
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