[Dysphagia] Logemann Robbins results

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

Hi Everyone,
Can anyone let me know if they observe pt aspirating on thickened fluid, will they prescribe thickened fluid? I think it common clinical sense.. you won't....I really wonder if these patients can even handle water or pureed food if they are aspirating on thickened consistency eg pudding consistency aspiration ..that is very severe dysphagia ..this person cannot live on water alone ..atleast I would keep the pt NBM, water sips for QOL if managed as per FWP and think of alternative feeding method. I think we tend to look for complex answers for time tested and simple clinical issue. We know that thickened fluid is not good for all esp.. the randomised study by Dr Logemann etal last discussed showing clearly difference in PD, DAT etc...clearly demonstrated that. I really cannot understand why some people are so obsessed about not giving thickened fluid when there is clinical evidence on MBS's that it has some advantages in some cases..this is clinical fact..yes I agree we have to be vigilant and see that we are choosing the right pts and weaning them out as quickly as possible back to normal fluid. ta   



Jai Gupta. M.Sc.(S.H.) CPSP MSPA 
Manager, Speech Pathology Department 
The Sutherland Hospital 
* Locked Bag 21, Taren Point  NSW  2229 Australia
* +612 9540 7111 page 594 or Direct +612 9540 7558  
*+612 9540 7717 *+61 0401 373 324 
<mailto:Jai.Gupta@ sesiahs.health.nsw.gov.au>  

A Thought 

You see things; and you say, "Why?" But I dream things that never were; and I say, "Why not?" ...... George Bernard Shaw


 






-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Irene
Campbell-Taylor
Sent: Thursday, 10 May 2007 1:23 AM
To: Cameron, Sharon (R3); dysphagia at b9.com
Subject: Re: [Dysphagia] Logemann Robbins results


The already existing literature seems to argue that not enough water is supplied and that even when patients drink all of the thickened fluids given, they still do not ingest/absorb enough water.
  Among other articles see:
  Inadequate fluid intakes in dysphagic acute stroke
  K.WHELAN
  Department of Nutrition and Dietetics, Kings College London, UK. (Correspondence to: KW, Research Dietitian, Department of
  Nutrition and Dietetics, Kings College London,150 Stamford Street, London, SE19NN, UK)
  Clinical Nutrition (2001) 20(5): 423?428
   

"Cameron, Sharon (R3)" <Sharon.Cameron at rvh.nb.ca> wrote:    As a Dietitian on the list, unfortunately I have not been privy to the
ASHA information. 

My question for those familiar with the research is a question about the
dehydration associated with thickened fluids. 
   
  

Is it a question that the fluid is bound by and therefore not available
to the body once thickened (more of a concern with gel thickeners) or is
it a question that once recommended, patients do not drink adequate
quantities of thickened fluids ? 

Any info greatly appreciated


Sharon Cameron
Registered Dietitian
Stan Cassidy Centre for Rehabilitation
800 Priestman Street
Fredericton, NB E3B 0C7
506-452-5652


-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Irene
Campbell-Taylor
Sent: Wednesday, May 09, 2007 11:57 AM
To: dysphagia at b9.com
Subject: [Dysphagia] Logemann Robbins results

For those who have difficulty with the links, the following is taken
from the original presentation at ASHA 2006:

Major Findings
Long term results show that despite differential effect of
interventions on immediate elimination of aspiration in
videofluoroscopic suite (Part I findings)......the 3-month incidence of
pneumonia was similar for chin down posture compared to thickened
liquids

( This, of course, emphasises again that what is seen on VFSS is not
necessarily what happens in real life.)

Adverse Events Hospitalization
Dehydration
(Presumably hospitalization for pneumonia and/or effects of
dehydration.)
Dehydration No difference in measured parameters Subset: n=16
Serum osmolality
Sodium
BUN (mg/dL)
Serum creatine (mg/dL)
Defined by primary physician
Was more frequent in thickened liquid arms (6% vs. 2%, p<0.05) 

Current Clinical Notion
"The thicker the liquid, the safer the swallow"
*Not true in patients who aspirate thick liquids - worse health
outcomes





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