[Dysphagia] VFSS

[JHummelbrunner at lwdh.on.ca (Hummelbrunner, Jackie)]

Hi Brad, the first thing comes to mind for me is the trial of
compensatory techniques.  I am curious to know what symptoms you found
in your clinical assessment as this would guide what compensatory
techniques may be beneficial (i.e was there tongue weakness?
Incoordination? Vocal quality? Airway closure?)  This patient may be
able to tolerate normal consistencies with the aid of one or two
compensatory techniques (Chin tuck? Supraglottic swallow?).  

The second thing that I am thinking about is that for a person of her
age (91 yrs), pharyngeal residue is not abnormal.  So if it is trace
residues in the vallecula then this may not be the key risk factor
contributing to aspiration and you may want to look at other factors
which may help you to address safety with a different approach.

Just some thoughts, hope they are helpful.

Jackie Hummelbrunner, M.Sc. Reg. CASLPO, S-LP (C)
Speech - Language Pathologist
Ont. Ca

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Brad Harvey
Sent: Thursday, January 05, 2006 6:05 AM
To: dysphagia@b9.com
Subject: [Dysphagia] VFSS

I have a question about the interpretation of VFSS.  One of my residents

recently had one done that showed residuals on the valleculae with
cookie, 
fruit cocktail, thin fluids and thick fluids.  Aspiration occurred 2 out
of 
3 attempts with thin fluids, none with thick fluids and 1 out of 2
attempts 
with fruit cocktail and it was suspect it was the thin fluid component.
The 
cookie left residuals, but no observed entry into the airway.  No cough
was 
observed with the aspirations.

The recommendation was for minced texture with honey thick fluids.  The 
resident is refusing to eat minced texture and thick fluids.  We have 
recently changed to already prepared thick fluids and she has agreed to
try 
these only after I explained the results of her VFSS and the likelihood
of 
aspiration and risk of pneumonia.  She is adament that she receive
regular 
texture which I have reluctantly agreed to.  She is her own POA and she
is 
91yo and feels it is a quality of life thing. I have the staff tracking
any 
difficulties and discussed appropriate interventions.

Is a digestive cookie not considered minced texture?  With residuals
being 
left with even thick fluids is there any increased risk providing
regular as 
I would think that pureed would be fairly comparable to thick fluids?

Your help is much appreciated,
Brad Harvey, RD


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