[Dysphagia] Dehydration and falls 2

[Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU (Jai Gupta)]

Irene said
  *** May I refer you to Groher, Logemann and others as to the fact that
VFSS never shows what happens in real life.  One can never say that one
intervention e.g.thickened fluids, causes anything or, more importantly,
prevents anything as 1) it is scientifically impossible to prove a
negative and 2) there are multiple other variables involved. 

Why do we do VFSS??? If it does not give us insight into what is
happening, Is the goal not to understand the neurophysiology and
biomechanics of swallow and trial appropriate intervention/strategies??
And see they work or not ....I find hard to swallow that a single
episode is not sufficient to make objective, imporatant and logical
clinical decisions...is it different to any other examinations like CT,
Chest Xray or blood test....I think to me even that one visualization of
swallow is always better then just observation. I do not deny that one
cannot make with experience good decisions but we should not undermine
the imporatance of VFSS. Caution yes ...undermine VFSS no...

Jai Gupta.  
The Sutherland Hospital 
 



-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Irene
Campbell-Taylor
Sent: Wednesday, 22 August 2007 23:53
To: apdfried at juno.com
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Dehydration and falls 2



"apdfried at juno.com" <apdfried at juno.com> wrote:    I work in acute care
hosp. and I'm on the  Falls Committee.  We have researched falls for one
year & the most common cause of falls is slow response to call lights
related to needing the bathroom.  
   
  *** I believe I made the point that the orthostatic hypotension
involved in falling when getting out og bed is frequently the culprit.
perhaps your Falls committee should look at
hypovolemia/dehydration/falls as these have been identified multiple
times as causing such accidents, often with lethal results. Or check the
Merck Manual of Geriatrics on both falls and orthostatic hypotension.
   
  Dehydration was not listed as a cause in any of the reports we saw.
Poor falls hx was the second largest cause since most fallers are repeat
offenders.
   
  *** Indeed it is - and dehydration, among other causes, is a constant.
   
  As far as thickening liquids goes I definitely think more is not
better and for years I have told students and other ST's honey thick is
as bad as no liquid at all as most people dehydrate.  I'm not ready tho
throw out the baby however as less thick alternatives can reduce
aspiration as clearly seen on videos
   
  *** May I refer you to Groher, Logemann and others as to the fact that
VFSS never shows what happens in real life.  One can never say that one
intervention e.g.thickened fluids, causes anything or, more importantly,
prevents anything as 1) it is scientifically impossible to prove a
negative and 2) there are multiple other variables involved.
   
   


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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