ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

M y T op 10 R esources for D ysphagia Asher Peet

I am a senior speech pathologist at Sir Charles Gairdner Hospital in Western Australia graduated from Curtin University of Technology in 2005, and have worked in an acute adult setting since that time. My major fields of interest are dysphagia, tracheostomy and FEES. As a speech pathologist in an acute tertiary hospital, I work predominantly with acquired swallowing disorders in an adult population. I find this area of work to be both challenging and rewarding, and the resources below to be invaluable in offering my clients a better service. I hope that other clinicians will also find them useful, either as a way to support their own skills or to share our knowledge with patients, caregivers and other health professionals.

1 Equipment: Pen-light, tongue depressors and mouth swabs I find these items essential to perform any bedside or outpatient swallow assessment. Thorough examination of oral musculature and anatomy are greatly assisted by these items, and I would never leave my office without them! 2 Gloves, eye goggles, hand wash I consider universal precautions for infection control to be indispensable in working with dysphagia. During bedside swallow examination, you frequently come into contact with the oral mucosa and saliva. It is also possible that coughing may increase your risk of exposure to transmissible infections. Simple barrier protection (gloves and eye goggles) and hand washing with good technique before and after contact significantly reduce the risk to both yourself and your patient. 3 My multidisciplinary team Management of dysphagia is an area of specialty for speech pathology. However, working in a team of health professionals can really increase the options you have available for your patient. n Input from medical staff is often essential to establish a diagnosis for the underlying condition related to dysphagia. Medical referral (and joint per­ formance) is also often necessary for instrumental examinations such as videofluoroscopy and fibre­ optic endoscopic evaluation of swallowing (FEES). n Our allied health colleagues – our job would be much more difficult without physiotherapists to advise on respiratory support and positioning, occupational therapists to assist with seating and modified cutlery, dietetics to work towards the most appropriate nutrition and hydration options, and social workers to help our patients source assistance in the community. n Nurses frequently carry out and monitor our recommendations, and may be the first to identify the need for a speech pathology referral. 4 The Passy-Muir tracheostomy observation model This model is a coloured plastic 3D representation of the head and neck in mid saggital cross-section. It is

extremely useful in pointing out the anatomical structures involved in swallowing to patients, families and other health professionals. In particular, I find it helps laypersons to visualise the location of the trachea and oesophagus, and understand the mechanisms of aspiration. It also has a “stoma” available for the placement of a tracheostomy tube – you can place and demonstrate the type of tube relevant to your patient. A wonderful way to practise inflating and deflating cuffs, and placing and removing valves and inner cannulas. 5 Recipes for “thinning down” thickened fluids at bedside Patients with dysphagia often need to have their swallowing function assessed with various fluid con­ sistencies. These consistencies may not be available in pre-mixed form at all sites. It is therefore important to ensure that the viscosity of the fluid you assess the patient with will be the same as the viscosity you order for them to have day to day. Studies have shown that “eye testing” or “spoon testing” is not a reliable way of measuring viscosity. At Sir Charles Gairdner Hospital in Western Australia, we have developed recipes to dictate how much fluid will be required to add to a L900 thickened fluid, to make a L400 or L150, according to our guidelines based on the line spread test. This strategy aims to provide a cost-effective and reliable way of having consistent viscosities for bedside assess­ ment. 6 A dysphagia “show bag” When patients are placed on a modified diet and fluids, they need adequate education and support to be able to understand the need for the changes and to produce them in the home environment. At Sir Charles Gairdner Hospital, patients and families are provided with a “show bag” upon discharge that includes education brochures, thickening powder samples and brochures, catalogues for commercially pre-mixed fluids, an instructional leaflet regarding their type of diet, and additional items as required (for example, Biotene products for oral care). 7 A neuroanatomy and physiology “cheat sheet” Another item I wouldn’t leave my office without! The neurological control of swallowing is complex, and it is

S p eech P athology A ustralia

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