ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

directly compare health outcomes of those patients on free water protocols with those on thickened fluids only. We have decided to modify our research protocol in the light of our experience to date, re-apply for ethics approval and then recommence recruitment. The research protocol will closely follow that described above with the most significant change relating to the instrumental assessment of aspiration. FEES was selected as the objective measure of aspiration because at the time the study commenced, it was more access­ ible for research purposes in our institution, and as valid as a modified barium swallow study (MBS) in discriminating between penetration and aspiration (Colodny, 2002). However, many eligible patients declined participation because of the invasive nature of the FEES. As MBS may be more acceptable to potential participants, and as most institutions we have contacted have better access to MBS than FEES, we have decided to change our research protocol and use MBS as our objective measure of aspiration. To reveal a statistical difference between groups, sufficient subject numbers are required and it is now apparent that it is not possible to recruit the required number of participants from within one institution. We are hopeful that other institutions with stroke patients will be able to assist with participant recruitment and data collection. An invitation We are hereby extending an invitation to acute or inpatient rehabilitation stroke units to join us in our research efforts. We could make this an Australian multi-centre randomised control trial, which along with the other evidence being collected in Australia, would potentially provide cutting edge information on the use of free water protocols. If you are interested in joining us, or for more information, please contact the authors. Concluding thoughts The main benefits of conducting research in the workplace have been the raised awareness and appreciation of evidence based practice, and a higher profile for the Speech Pathology Department both within and beyond our institution. Moreover, benefits in patient care have been observed, with positive changes in nursing staff’s regular care of stroke patients, with respect to their knowledge of and practice in dysphagia, oral care and patient hydration. References Braunack-Mayer, A., & Hersh, D. (2001). An ethical voice in the silence of aphasia: Judging understanding and consent in people with aphasia. Journal of Clinical Ethics , 12 , 388–396. Bulow, M., Olsson, R., & Ekberg, O. (2003). Videoradio­ graphic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids. Acta Radiologica , 44 , 366–372. Carroll, L., Ledger, M., Cocks, N., & Swift, L. (2007). I’m still thirsty: What are the consequences of allowing elderly patients with dysphagia to drink water? Paper presented at the Speech Pathology Australia National Conference, A Different Perspective, Sydney, 28–31 May 2007. Chalmers, J. M., King, P. L., Spencer, A. J., Wright, F. A. C., & Carter, K. D. (2005). The oral health assessment tool: Validity and reliability. Australian Dental Journal , 50 , 191–199. Colodny, N. (2002). Interjudge and intrajudge reliabilities in fibreoptic evaluation of swallowing (Fees®) using the penetration–aspiration scale: A replication study. Dysphagia , 17 , 308–315. Finestone, H. M., Foley, N. C., Woodbury, M. G., & Greene- Finestone, L. (2001). Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and non- oral strategies. Archives of Physical Medicine and Rehabilitation , 82 , 1744–1746. Garon, B. R., Engle, M., & Ormiston, C. (1997). A randomized control study to determine the effects of unlimited oral intake

of water in patients with identified aspiration. Journal of Neurological Rehabilitation , 11 , 139–148. Institute of Medicine of the National Academies. (2004). Dietary reference intakes for water, potassium, sodium, chloride, and sulfate . Washington DC: National Academies Press. Kagan, A., & Kimelman, M. D. Z. (1995). Informed consent in aphasia research: Myth or reality. Clinical aphasiology, 23 , 65–75. Kuhlemeier, K. V., Palmer, J. B., & Rosenberg, D. (2001). Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia , 16 , 119-122. Langmore, S. E. (2001). Endoscopic evaluation and treatment of swallowing disorders . New York: Thieme. Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J., Lopatin, D., et al. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia , 13 , 69–81. Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke , 36 , 2756–2763. Mills, K. (2008). Wet your whistle: The introduction of a free water policy at the Royal Melbourne Hospital – City campus . Paper presented at the joint conference of the New Zealand Speech-Language Therapists Association and Speech Pathology Australia, Reflecting Connections, Auckland, 25 – 29 May 2008. National Stroke Foundation. (2008). What is a stroke: Fact, figures and stats . Retrieved 28 July 2008, from http://www. strokefoundation.com.au/facts-figures-and-stats Panther, K. (2003). The Frazier Rehab Institute Water Protocol . Retrieved 27 July 2008 from http://www.kysha.org/06%20 Handouts/MS%203F%20Panther%20Handout2.pdf Patch, C. S., Mason, S., Curcio-Borg, F., & Tapsell, L. C. (2003). Thickened fluids: Factors affecting wastage. Advances in Speech-Language Pathology , 5 , 73–77. Scott, A., & Benjamin, L. (2007). The introduction and review of a free fluid protocol in an aged care facility . Paper presented at the Speech Pathology Australia National Conference, A Different Perspective, Sydney, 28–31 May 2007. Schmidt, J., Holas, M., Halvorsen, K., & Reding, M. (1994). Videoflouroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia , 9 , 7–11. South Australian Dental Service. (2004). Oral health protocols for residential aged care facilities . Retrieved June 2008 from http://www.sadental.sa.gov.au/ Wu, M., Chang, Y., Wang, T., & Lin, L. (2004). Evaluating swallowing dysfunction using a 100ml water swallowing test. Dysphagia , 19 , 43–47. Acknowledgements We would like to thank the Primary Health Care Research Evaluation and Development, Department of General Practice, Flinders University for their initial set-up grant of $4,880 and their writing grant of $3000; and Allied Health Research Grants, Royal Adelaide Hospital, SA, for two grants of $6000 and $1900. We would also like to acknowledge our co-researchers: Maree Creevy, Debra Ormerod, Alinka Krol and Alison Mapleson. Jo Murray is a speech pathologist of 22 years who works with adults with acquired neurological conditions. Anna Correll is a speech pathologist who works in adult rehabilitation in Adelaide. Correspondence to: Jo Murray Hampstead Rehabilitation Centre, 207–255 Hampstead Road, Northfield SA 5085 email: Jo.Murray@health.sa.gov.au

ACQ uiring knowledge in sp eech , language and hearing , Volume 11, Number 1 2009

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