[Dysphagia] Logemann results

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

All considerations of aspiration and its effects are 1) is it oropharyngeal or gasroesophageal or a mix and b) what are the four essential variables -the most important being the patient's immune response. All of these are or primary importance over and above the fact of the aspiration itself.

Kimberly Rossman <kimberlyrossman at yahoo.com> wrote:    Hi All,
   
  Interesting and enlighting discussion we have going here!  
  I have been using what I call naturally thickened consistencies to make my items thicker...what I mean by that is using nectar juices like peach, pear or nectar juice that are thick like V-8 juice without added chemicals.  I also have made a honey thick liquid that is naturally thick using sherbet and pudding which is all liquid to help compensate for the dehydration concern.  My question is not in regards to whether thicker is aspirated more, (I know a little about the research and am trying to find a balance between thickening and not ((as I am sure many of us are)); but, if items are naturally thickened, does aspirating them have the same concerns?   I know we all want to do what is best for our patients and I'm curious if anyone knows of research that supports this approach as it seemed like a balance between not thickening and thickening to me.  I know that I have advocated before that people not be placed on thicker liquids as they are likely aspirating them, but
 over-ruled by nsg or MD so this has been my proposal that has seemed to placate everyone!
  Curious,
  Kimberly

Paula Garbin <paula.garbin at gmail.com> wrote:
  This entire debate continues to demonstrate unfortunately that there is
nothing concrete or consistent in our field. Research continues to
contradict itself, and when one method appears to work, a new study comes
out that disproves it. All patients are different and as we all know when
you do therapy its trial and error. And I agree, in terms of a VFSS, you
can't simulate an entire meal, and there is fatigue to consider as well as
the countless number of aspiration precautions that the patient needs
to follow, it puts the therapist in a very difficult situation sometimes.
Thickened liquids are not always the answer, and sometimes we have to be
aggressive in our approach when we are making the final decision between
thins and thicks; taking more of a holistic approach when making a final
diagnosis. Bottom line I think we have to do the best with what we can and
what our knowledge base is.

~Paula A. Garbin, M.S., CCC-SLP


On 5/9/07, Irene Campbell-Taylor wrote:
>
> These are the patients most often found in LTC ? and the Parkinson's with
> dementia is actually the parkinsonian stage of dementing illness. I don't
> believe anyone has made general statements about all dysphagic patients ?
> simply that, contrary to popular belief, thickened fluids are aspirated, the
> thicker more than the thinner (as Perlman proved years ago), and, as the
> authors say, it is probable that the lungs' ciliary motion cannot clear the
> gum-based thickener used. If so, this would apply to all since lung function
> is not affected by dementing illness.
> The importance of the findings is mainly to point out that the almost
> universl belief that thickening prevents aspiration is false and that
> dehydration is a constant danger.
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com