JCPSLP Vol 23 Issue 2 2021

4. Sensory modification was used to capture any strategies used to maximise the sensory experience on drinking and included use of intense flavours, cold temperature and use of added carbonation. 5. The 45˚ recline postural tilt was considered separate to other swallow postures as this one involves reclining the upper body halfway between sitting upright (traditionally 90˚) and lying down, therefore at a 45˚ position (Park et al., 2013). 6. Syringe drinking is the use of a syringe to deliver fluids into the mouth. This strategy was captured separately to the alternative delivery category as it is traditionally discouraged (Lazarus, 2004) and we wanted to explore if it is still being used and how frequently. 7. Free Water refers to the Frazier Free Water Protocol which is a set of guidelines that allows access to water for specific individuals with thin liquid dysphagia. This allows patients to drink water between mealtimes following strict oral hygiene guidelines. It has been used for more than 20 years in rehabilitation settings, with high success in maintaining patient hydration even in the circumstance of known aspiration (Gillman, Winkler & Taylor, 2017). The Survey Monkey descriptive statistics of numbers, percentages and mode were reviewed for the participant responses to all the closed and ranking items in the survey, including participant demographics, their self-reported clinical practices and the perceived influences on practice. Within-group and between-group patterns between subsets of participant demographics were explored. While the full survey included 10 questions, only the items relating to demographic information along with knowledge, use and skill with swallowing strategies are reported in this paper. SLP responses regarding their priority for safe drinking will be presented elsewhere, including participants’ proposals for the highest priority specific research questions related to safe drinking in their own area of practice. Findings Participant demographics A total of 224 SLPs replied to the survey, with the majority working with adults (79%, n = 178). Within the adult caseload, most SLPs (34%, n = 77) worked in the field of adult learning disability. Figure 1 shows the range of clinical populations and settings where the participants worked and demonstrates the relatively higher proportion of dysphagia caseload work with adults compared with paediatric populations. The responses showed that the survey respondents were experienced in dysphagia practice, with two-thirds having over six years’ experience. There was a spread of years’ experience working in dysphagia, as shown in Table 1. Frequency of strategies recommended Figure 2 shows the frequency of strategies recommended by SLPs. The most frequently used strategy was alternative delivery (74%, n = 165 always or often) such as, fluids given via teaspoon, straws, or modified cups). The second most frequently used strategy was drinking techniques (62%, n = 137 always or often) such as pacing or chin tuck. Just over half of SLPs reported they always or often recommend thickener (51%, n = 112) as the third most frequently used strategy. The other four strategies were less frequently reported by SLPs. Fewer than than a third of SLPs always or often recommended sensory modification (31%, n = 69) and very

6,3%

25,11%

33,15%

31,14%

52,23%

77,34%

Adult community Children community

Adult acute

Adult learning disability other

Children acute

Figure 1. Clinical caseload of SLP participants (number, percentage)

Table 1. Participants’ experience in dysphagia practice

Years of experience in dysphagia

% n

Less than one year

5% 11

1–5 years

29% 66

6–10 years

22% 49

11–15 years

13% 28

16–20 years

13% 30

More than 20

18% 40

Table 2. Other drinking strategies specified by participants.

Other drinking strategies specified by participants

1 a supporter giving drinks to an individual rather than a person drinking independently 2 regulating bolus size

3 advising single sips versus continuous drinking 4 recommendations to increase postural support 5 head position for swallowing 6 jaw stability 7 making recommendations regarding bottle teats 8 supervision

few reported they always or often use a free water protocol (14%, n = 31), 45˚ recline (9%, n = 19), or syringe drinking (1%, n = 3). As well as the above strategies, participants were given the option to add other specified strategies that they recommend in their routine practice. These responses are shown in Table 2. It could be argued that some of these approaches may be included under the classification of alternative delivery or drinking techniques as defined in this study; but these items are reported here to illustrate the need for a more accurate and standardised taxonomy of descriptors to be advocated across SLP practice.

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology