[Dysphagia] Flexible thinking

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

Why does Logemann have then suggest trial of 1, 3 5, 10 and 15ml ++ in
VFSS and Bedside Ax .. I have seen some pts who do very well with spoon
and bad on larger bolus ....over years I have learn't there are no
blanket rules in dysphagia ...when I say impossible the word itself tell
me I'm possible. Goodluck for those who like the concept of blanket
rule.


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: Friday, 24 August 2007 5:35
To: dysphagia at b9.com
Subject: [Dysphagia] Flexible thinking

 The writer says that it is hard to maintain hydration with sips or
teaspoon. Indeed it is and teaspoons are the worst means of feeding
anyone - how's that for a blanket rule? Anyone ever tried it? Please do
and you'll see what I mean. More importantly, it has been repeatedly
shown by Logemann, Kahrilas and others that the larger the bolus the
more efficient the swallow.
  I.V. for chronic hydration? Never. But clysis is used widely for
exactly that - don't know why the US is so far behind the rest of the
world. Medicare even has a code for payment.
  Flexible thinking? Would that it happened. I can't say that I see much
of it however desirable it may be but there are some blanket rules in
medicine whether we like it or not. 
  The clinical examination is, in my experience, almost never taught or
taught incorrectly - no cranial nerve assessment, belief that tongue
movements outside the mouth have anything to do with swallowing when
they don't, no assessment of the brain stem, belief that a "wet voice"
means aspiration when it doesn't and on and on. It's not for nothing
that every study ever done of agreement between SLPs on swallowing
assessment and treatment has shown that there is none. 


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