[Dysphagia] food holding

[KHouts at stanfordmed.org (Houts, Karen L)]

The first thing that crosses my mind is to talk to a Dr. & look for reversible possibilities that caused his decline, ie dehydration, electrolyte imbalance, low grade infections or heaven forbid Normal Pressure Hydrocephalus. Your description of him could be the classic NPH triad of decline in cognition, bladder control and gait. Another possibility is a change in medications or his ability to handle his same medications as he ages. If you go thru all that and he still holds his food, I have had good results with the following:
1. Hand over hand guiding for self feeding ( if he ever fed himself)
2. Asking a question when he is holding the food in his mouth ( if he speaks)
3. Downward pressure to the tongue when placing the food & slightly dragging the spoon forward  as you  
    remove it from his mouth.
4. If it still doesnt work, change his diet to drinkable items.
5. If he holds liquids in his mouth you can have him try using a straw to get the liquid farther back in his 
    mouth, encouraging the liquid to spill into the pharynx & a spontaneous swallow, or in a semi reclined  
    position using gravity instead of suction for the same reason.
 
Hope this helps, Karen Houts, OTR/L-SWC

	-----Original Message----- 
	From: hillivie423@adelphia.net [mailto:hillivie423@adelphia.net] 
	Sent: Thu 5/12/2005 1:21 PM 
	To: Dysphagia list 
	Cc: 
	Subject: [Dysphagia] food holding
	
	

	Does anyone have any suggestions to support a 72 year old gentleman who has profound mental retardation, eats a soft cooked, diced diet that is spoon fed to him by a staff person.  He has recently shown some changes that might suggest a dementia, such as taking a bite of food and then holding it in his mouth for several seconds, apparently not knowing what to do with it.  He also has had a couple of incidents of urinary incontinence, to which he did not respond.  He had previously taken himself to the bathroom consistently.  He also has always walked independently, but is now unsteady in his gait.  I'm looking for any ideas that have worked for others, in how to cue him to swallow.
	Thank you.
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