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Do's and don'ts for dysphagia


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#1 jas1125

jas1125

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Posted 23 October 2013 - 09:30 AM

Hello:

My mother, age 84 just did a modified barium swallow and it was found she silently aspirates thin liquids. As such, she will now need to be on nectar thick liquids. She is in assisted living, and they have in house therapy, so speech therapy will begin shortly. After a 6 week program, they want her re-tested to see if there is any improvement. This is a deterioration from 18 months ago, when the same test showed only silent aspiration when using a straw. She was given exercises to do, however her compliance was not a dedicated as I had hoped despite prompting.

 

Her facility has thickening agents, as well as the pre-mixed flavored water and I want to make sure that she stays hydrated, as she is prone to UTIs. In reading various sources, it stated some over the counter thick fruit juices are ok to give, such as apricot nectar or tomato juice, however her therapist indicates no, everything must be thickened. I'm looking into different ways to do this, such as adding MIO flavor enhancers to thickened water and to give it some variety. Is there a specific lists of do's and don'ts that I should be aware of?

Also, she takes liquid Tylenol for pain and a liquid multi-vitamin....do they also need to be added to thickened water? How about vitamin gummies? She enjoys those and they seem like they would be OK, but I want to make sure.

 

This all came about when a new finding of pulmonary fibrosis was given 2 months ago, and her pulmonologist wanted a repeated swallow test to determine the cause. Although this is something new that must be dealt with, I'm hopeful this will help to reducet her risk of pneumonia, which she's had a few times over the last 3 years.

 

My apologies for the length of this post, but since I'm proactive in her care, I want to make sure I do the right things for her.

 

Thanks very much for any information that you can provide.



#2 Dr. Mahler

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Posted 25 October 2013 - 01:18 PM

The motor changes associated with PD can definitely affect swallowing.  Although people with PD share a common etiology there is great heterogeneity within the population regarding the cause of swallow problems so it is good that your mother is getting consistent treatment.  If the SLP's recommendation was for thickened liquids then typically even water needs to be thickened.  Her SLP is in a better position to advise you about the liquid Tylenol than I since she has seen her in person. 

 

Research literature teaches us that people with PD can benefit from exercise treatment to improve swallowing. 

Muscle strengthening exercises may increase tongue strength and range of motion in elderly and may also help people with PD.  (El Sharkawi et al., 2002; Logemann, 1998; Robbins, et al., 2005).  A randomized study of 3 interventions on immediate aspiration of thin liquids in patients with PD (with and without dementia) was completed by Logemann, Gensler, Robbins, Lindblad, Brandt, Hind, Kosek, et al., (2008).  They compared nectar thickened liquids, honey thickened liquids and chin tuck.  They found that honey thickened liquids were best at eliminating immediate aspiration but there were other complications that resulted from decreased fluid intake.  Compensatory strategies may prevent aspiration but do not influence or improve the underlying pathophysiology of the swallow.  Principles of exercise applied to the behavioral treatment of swallowing disorders have demonstrated improved swallow function.  Those principles include: intensity, specificity, and transference (Burkhead, Sapienza, & Rosenbek, 2007; Robbins et al., 2007).

 

Talk with your mother's SLP about whether she might be a candidate for a daily swallowing exercise program to maintain or possibly improve the safety and efficiency of her swallow before the repeat modified barium swallow study.

 

Please write again if you have any additional questions.

 

 

 

Sincerely,

 

Leslie Mahler


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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