[Dysphagia] Aggressive MR POC

[pressmah at sjhmc.org (Pressman, Hilda)]

Pt should also be assessed and/or treated for reflux.  Mouthing behaviors
are often reduced with treatment.  Mouthing produces increased secretions
which help to neutralize the acid.  If the pt is feeling "heartburn" the
mouthing behavior is helping him.  Hilda Pressman

-----Original Message-----
From: Sanders, Liza [mailto:LSanders@cvtc.state.va.us]
Sent: Wednesday, May 19, 2004 10:56 AM
To: 'Jill Silverman'; 'dysphagia@b9.com'
Subject: RE: [Dysphagia] Aggressive MR POC


It is difficult to sort through all of the problems that persons with
complex issues have.  It sounds like the chewing/biting/SIB is part of the
larger issue that is also being addressed with this person.  Maybe looking
at it as part of the big picture rather than just the behavior itself will
yield answers.  I would imagine that this person is on psychotropic
medication and that his response to it is closely monitored.  Is the
psychologist writing a behavior treatment plan to go with the medication
monitoring now or is a plan already established?  Whatever is done with
regard to the biting would need to be included in this.  What are the
reasons that the behavior occurs?  Has there been an OT consulted to do a
sensory work up?  This person could have sensory needs (proprioceptive,
vestibular, etc.) that are not being met.  Are there environmental triggers?
It definitely takes the whole team to work through these issues.  I don't
see this as a SLP or psychology issue alone.  There is certainly a limit to
what we as SLP's have to offer if these other things are not thoroughly
evaluated.  

I agree with what everyone says about the chewy tubes being appropriate for
any age.  Does this person have PICA behavior?  That is the big concern that
I would have with giving something like this to this person.  

 -----Original Message-----
From: 	Jill Silverman [mailto:JSilverman@dhmh.state.md.us] 
Sent:	Wednesday, May 19, 2004 8:31 AM
To:	dysphagia@b9.com
Subject:	[Dysphagia] Aggressive MR POC

     Hi All!  I would first like to thank those who provided me with helpful
suggestions for completing the gum trials with the individual I described in
my e-mail last week - against my better judgement - per Senior Management's
directive.  As I expected, he swallowed the gum immediately and engaged in
SIB - biting his arm and hitting his head - even with the gum...Needless to
say, we are thankfully NOT moving forward with that idea...Thank G-d!!!
   However, the Team (or in other words me and the Psychologist) are now
left with the difficult mission of designing another plan.  Please remember
this man is violently aggressive, nonverbal, profoundly mentally retarded,
h/o seizure disorder, & Diabetic - so edibles would certainly complicate
things - even though I do not habitually prefer to use edibles.  With this
group of developmentally disabled individuals who reside in an ICF/MR, often
food is the only natural motivator that is effective...I researched and
suggested mouthing tools (or, chewy toys, tubes, teethers) as something we
might try and was honestly "heckled" and told they were not age appropriate.
Now, yes, this man is in his 40's, but cognitively, he functions at
approximately 6-12mos...Others "prefer" squeeky toys, activity boxes,
mobiles, etc...Why then is my idea so preposterous?!  ANY other ideas anyone
could offer will be sincerely helpful!!!  
Respectfully yours, and awaiting your suggestions, Jill Silverman

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