[Dysphagia] Practice approaches

[eripley at yahoo.com (Irene Campbell-Taylor)]

gerriann jackson <gjackson at rochester.rr.com> wrote:    

I promote free water between meals, after oral care for my dysphagia
patients.
   
  *** Even the best oral care can never remove all pathogens from the mouth. I cannot, however, ignore the many videos that I have performed
that demonstrate quite clearly a person aspirating on thin and tolerating
thickened liquids. 
  *** You really must take these findings as what they are- not relevant to real life. Logemann in her study on thickeners noted that the VFSS did not match the real life situation - it never does. 
   
  Nor can I ignore the patients who I follow over time
(LTC attached to hospital) who have experienced relief from chronic upper
respiratory symptoms, including repeated pneumonias after being placed on
thickened liquids.
  *** But you don't know all of the variables involved. They are, undoubtedly, aspirating the thickened liquids as well. See Logemann et al.  Perhaps, for other reasons, their resistance is better. One cannot assume that thickened liquids are not aspirated and we now know for certain that they are.

Research and evidence based practice are important to my practice. However,
there is also evidence and knowledge to be gleaned from every patient that I
treat. 
  *** Absolutely - but one must also know what changes, biochemical, pharmaceutical, immunological, etc. are taking place before reaching conclusions based on only one variable.
   
  Those patients and their outcomes tell me that although probably
overused, there is an appropriate place for thickened liquids in the LTC
setting.
  *** I, of course, would have to disagree, and, having never used them find no reason to suggest that they do have any place - the recent study supporting this conclusion.

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Dr I Campbell-Taylor
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