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[Dysphagia] RE: Dysphagia Digest, Vol 16, Issue 11
"Brown, Suzanne R." <brownsr@health.missouri.edu> wrote:
SECOND, how do we know the dynamics of the swallow if we don't test the swallow under different conditions (cohesive moist solids, dry/crumbly solids, tough to chew solids, solids mixed with liquid - fruit cocktail or soup)?
*** I suppose you should pose that question to thsoe who have done the most research - Cook, Shaker, Logemann, Kahrilas, etc. etc using only barium.
aspiration has lead to pneumonia in some of our patients.
*** No doubt - but the question remains, aspiration of what?
We get a lot of patients who have compromised respiratory systems or who don't get out of their wheelchair all day. In normal healthy people, aspiration shouldn't be a problem, but in a patient that has been in the hospital for 2 months to 1 year who has... hemiparesis, gener!
alized weakness, COPD, vent dependent, bed/wheelchair bound, cognitively impaired, etc, it seems that aspiration can be the straw that breaks the camel's back.
*** Of course - the most important variable - the pateint's resistance factor. But these are the very pateints who get pneumonias from aspirating their own saliva - still the leading cause of nosocomial pneumonia regardless of what they eat or drink.
THIRD, using the VFSS to assess effectiveness of compensatory strategies. If you don't mix barium with the consistencies that are giving the patient trouble, then how do you know which compensatory technique will work, or how it works?
*** You still don't know because it's an unreal situation. The compensatory strategies are tried in real life, based on the information from history and clinical examination and, when VFSS is done, as it needn;t be done always, from the information on the dynamics obtained therefrom.
When food/liquid is presented, we tend to just look for pooling, residue, penetration, and aspiration and FAIL to look for WHY these things happen.
*** I regret to hear that since the why is the most important aspect and, BTW, I don't look mainly for pooling, residue and aspiration at all.
We need to train ourselves to look at the base of tongue, pharyngeal bulging (following the bolus), and anterior hyoid movement,
*** Who doesn't look for these? Anterior pharyngeal bulging can be a pseudotumor and a sign of a long standing problem. But the major issue in swallowing dynamics is hyoid movement, arytenoid movement and tongue function in general - all of which can be assessed quite successfully by clinical means.
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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