1. Medical Practicum Goals/Objectives of First Visit Tour of facility
Cog/Language Screening
MoCA and/or SLUMS
Observe patients during mealtime
Observe Patient consuming alternate diet
Oral Motor Exam

2. When will we go? You will go for 2 hours, 1x this term
It is nice to go during mealtime, therefore;
Fridays 11-1
Monday or Tuesday 4-6

3. How do I sign up? Via SIGN UP genius DO’s – Please carpool if possible
me with questions or concerns
PLEASE DON’T- me via sign up genius

4. Liquid & Texture Modification in Patients with Dysphagia
Spring 2017

5. Swallowing Screening Have you ever watched people at mealtime?
Dentition
Managing secretions
Pacing ( fast or slow)
Feeding themselves?
Coughing or choking

6. GOAL
Primary goal in dysphagia therapy is to meet nutrition and hydration needs by mouth – while minimizing the risk of aspiration

7. Approaches to Treatment of Dysphagia
Compensatory strategies
Compensate for lost function
Do not target change in swallowing physiology
Strategies include posture modification, diet texture modification etc.
Used during meals
Facilitation strategies
Intended to change selected aspects of swallow physiology
No food needed to teach maneuvers
Other

8. Compensatory Strategies
Posture modification
Modification of bolus volume
Modification of liquid and food consistencies
Modification of how food is presented to patient
Enhancing sensory input
Special eating utensils

9. Facilitation strategies
Swallowing maneuvers - examples
Effortful swallow
Supraglottic/Super-supraglottic swallow
Mendelsohn maneuver
Physical Exercises - examples
Head-lift exercises
Oral-motor exercises to increase vertical, lateral ROM of lingual movements in cancer patients

10. Other considerations Reducing distractions during meals
Assistance during feeding
Support with oral hygiene

11. Study – thickened liquids
Diet texture modification and thickening liquids should be used as a last resort (Logeman, 1998)
Large-scale study with stroke, PD, and dementia patients - compared chin-tuck and thickened liquids (Logeman et al., 2008; Robbins & Hind, 2008)
Part I (N=742) - Eliminating aspiration
49% aspirated on all 3 interventions
Honey-thick liquid < nectar-thick liquid < chin tuck
Part II (N=515) - Preventing pneumonia
Pneumonia within 3 months occurred in 52 participants (11%)
Lower incidence of pneumonia in patients randomized to nectar-thick than those on honey-thick

12. Using thickened liquids Factors to consider (Garcia et al
Using thickened liquids Factors to consider (Garcia et al., 2005; Mills, 2008)
Absorption of water by the digestive system
Patient acceptance of thickened fluid
Mixing characteristics
Starch-based thickener – unstable, thickens over long period of time, varies across liquid types
Xanthan-gum thickener – more stable over time & across liquid types & different temperatures
Absorption of water by the digestive system

13. Diet Texture Modification National Dysphagia Diet
NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).
Regular (all foods allowed).

14. COMING SOON

15. References
Garcia, J. ,Chambers, E., & Molander, M. (2005). Thickened liquids: Practice patterns of speech-language pathologists. American Journal of Speech-Language Pathology, 14(1), 4-13.
Logemann, J. A., Gensler, G., Robbins, J. A., Lindblad, A.S., Brandt, D. K., Hind, J. A. et al. (2008). A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. Journal of Speech, Language, and Hearing Research, 51,
Mills, R. H. (2008, October 14). Dysphagia Management: Using Thickened Liquids. The ASHA Leader.
Robbins, J., & Hind, J. (2008). Overview of Results From the Largest Clinical Trial for Dysphagia Treatment Efficacy. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 17(2), 59–66.
Sharpe, K., Ward, L. Cichero, J., Sopade, P., & Halley, P. (2007). Thickened fluids and water absorption in rats and humans. Dysphagia, 22,