Question
I would like to know you philosophy regarding outpatient dysphagia treatment. I have recently taken on a patient who has been seen in our clinic for about 10 months. Sessions have ranged from weekly to once in 6 weeks. He has had 3 video swallow studies
Answer
There were a few questions posed in this paragraph. I feel that outpatient therapy needs to be consistent. For outpatient dysphagia treatment I typically see patients 2x-3x/week. You have been seeing this patient for 10 months which is a bit long. Is there a reason why he was only coming in once in a 6 week period? I do feel consistent therapy is warranted as long as progress is being made. Sometimes with patients who have dementia, progress will be slower. If strengthening exercises are not benefiting him you may need to place him on a diet that is felt safe and reevaluate on a quarterly basis, with a new physician referral for each assessment. Because of the dementia is there carryover and compliance with recommendations?
In regards to oral hydration, according to your paragraph this patient did not show penetration or aspiration on nectar consistency. Spillage into the valleculae can be seen as a deficit, but it sounds as if this patient was able to clear the valleculae with an independent second swallow, which is great! Is he able to demonstrate this second swallow strategy independently on a regular basis and verbalize its importance? I feel that initiating trials of nectar consistency would be a definite next step. Is there a reason why his honey liquids were limited? Was he fatiguing? I would definitely work on increasing his oral hydration and decreasing his g-tube hydration.
One other point that was noted in the paragraph was that the patient had previously had bacterial pneumonia. You may want to educate him on good oral hygiene and the risks of bacteria in the mouth transferring to the lungs if good oral hygiene is not achieved.
I hope this answers your questions. Please don't give up! Create a game plan and stick with it. If you increase your frequency of treatment you may see a quicker discharge from services.
My name is Beth Griffith. I have been a speech therapist for 10 years. I work with all ages. Currently I am working for a private practice, giving me a great opportunity to work with a variety of cases. Through this private practice I have the opportunity to continue to work in nursing homes and hospitals. Prior to working in private practice I worked in a hospital setting for 5 years in ICU/Acute care, rehab and outpatient as well as completed Modified Barium Swallow evaluations almost daily. I have a passion for dysphagia therapy and do feel it is one of my strengths.
Beth Griffith, M.A.,CCC-SLP
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