JCPSLP Vol 20 No 3 November 2018

Nutrition, swallowing, mealtimes: Recipes for success

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longer and require more effort to eat than others. In short, participants made self-limiting choices in the interests of time and safety which sacrificed some level of enjoyment and satiation. When eating out, challenges in the physical and social contexts included poor building access, limiting venue choice; restricted meal options as they ordered food based on texture rather than preference; reliance on assistance from others; and outdated equipment. Younger participants (15–17 years) reported fewer negative experiences than the older participants (19–23 years) and it was hypothesised that this finding may be related to the younger people still living at home, in addition to potentially fewer physical and swallowing challenges that are associated with growth in late puberty. Overall, the participants described their eating and drinking difficulties as only minor and they valued their abilities to consume food and drink orally. However, it is evident that this population experiences many barriers to enjoyment and participation in mealtime events. Reference Balandin, S., Hemsley, B., Hanley, L. & Sheppard, J. J. (2009). Understanding mealtime changes for adults with cerebral palsy and the implications for support services. Journal of Intellectual and Developmental Disability , 34 (3), 197–206. DOI: 10.1080/13668250903074489 Jones, O., Cartwright, J., Whitworth, A., & Cocks, N. (2018). Dysphagia therapy post stroke: An exploration of the practices and clinical decision- making of speech-language pathologists in Australia . International Journal of Speech-Language Pathology , 20( 2), 226–237. Clients with dysphagia post stroke are a heterogenous population by way of their dysphagia type, communication/ cognitive skills and medical status (to name but a few variables). Consequently, the therapy approaches employed by speech-language pathologists (SLPs) to treat dysphagia post stroke and the factors that influence their clinical decision-making are equally as diverse. Although variability in the provision of therapy may indeed be responsive to the distinct needs of clients with dysphagia post stroke, limited consistency in the implementation of therapy may also have implications for the equity and quality of dysphagia services for this population. In response to an enhanced understanding of neuroplasticity and its application to rehabilitation post stroke, traditional compensatory approaches to dysphagia therapy (i.e., diet/fluid modifications, postural adjustments) have been augmented by a selection of rehabilitation Natalie Berg

Remijn, L., van den Engel-Hoek, L., Satink, T., de Swart, B.J.M., & Nijhuis-van der Sanden, M. W. G. (2018). “Everyone sees you sitting there struggling with your food”: Experiences of adolescents and young adults with cerebral palsy. Disability and Rehabilitation , 28 , 1–8. doi:10.1080/09638288.2018.1451923 Harmony Turnbull Mealtimes are a central part of the lives of many people. For adolescents and young people, valuable socialisation often involves consumption of food and drink while visiting places like the cinema, shopping plazas, or movie nights at a friend’s house. It is important for clinicians to remember that dysphagia can impact beyond a patient’s health and physical needs to social and psychological areas of development. Mealtimes are not only about hydration and nutrition, but they also facilitate participation in activities like birthday parties and festive celebrations. This article by Remijn et al. (2018) further develops work by Balandin, Hemsley, Hanlin and Sheppard (2009) who explored self-perceived impacts of mealtime difficulties for adults with cerebral palsy, reporting from the individuals’ perspectives. Research and reporting of this kind is rare and adds valuable information to strengthen the person- centred practices of clinicians working with people with complex needs. In this small qualitative study, the 10 Dutch participants were between 15 and 22 years of age, and recruited through an online support group. They were involved in individual, face-to-face interviews that explored their mealtime experiences, food choices and self-perceptions of mealtime and swallowing difficulties. Participants were either in assisted living, lived in a “care centre”, or lived with their parents. All consumed an oral diet and rated their eating and drinking skills from 6/10 to 9/10, where 1/10 was “not good” and 10 /10 was “good”. Only 1 of the 10 participants had recently accessed a review assessment and intervention. The majority had not received any form of monitoring or intervention for many years despite an apparent need. The authors found four main themes from the interviews, regarding experiences with eating: (a) perceived eating and drinking difficulties; (b) actual challenges in physical and social context; (c) dealing with eating and drinking difficulties; (d) personal negative feelings toward their eating and drinking experiences. Negative feelings toward eating and drinking were linked to physical abilities or limitations of managing utensils and mastication, in addition to the restrictive time allowed for meals in workplaces or schools and eating in social situations. Participants reported self- limitation of food choices or amounts of food, as they recognised not only that some foods and textures were more hazardous than others, but also that some foods take

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology