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[Dysphagia] VFSS
Brad,
A few questions/points to consider...
-If this Pt did not asp "thick" liquids, why was "honey" rec vs "nectar"? Nectars are sometimes more acceptable-all thick liquids run the risk of dehydration anyway
-If this Pt is mentally intact/can learn/use new information, a multiple swallow can be
tried a a way to reduce residue (this should have been done under fluro!)
-Any food is "pureed" if it is chewed well enough prior to swallowing-what is this Pt's
mastication/oral phase like (this should be in the video report)?
-What is this Pt's overall health like? pulmonary/mobility/immune system...although
91, if she's in pretty good shape, some asp can be tolerated w/o asp pneumonia-
the percentage of folks that actually get asp pneumonia is low, based upon other factors
-Is the SLP involved? I would imagine so if the Pt had a VFSS-If the Pt is insisting on
reg solids (maybe she will agree to mech soft?) the SLP can do clinical meal analysis with reg texture, and see if there are any s/s residue during a full meal, can the Pt do the mult swallow, is the Pt willing to use necar thick for all liquids except H20?
there are numerous compromises that can be made.
-It sounds like the VFSS was missing some information, such as when was the asp noted...prior to or after swallow. This info changes strategies and POC
A. Schoenagel, SLP
"Hummelbrunner, Jackie" <JHummelbrunner@lwdh.on.ca> wrote:
Hi Brad, the first thing comes to mind for me is the trial of
compensatory techniques. I am curious to know what symptoms you found
in your clinical assessment as this would guide what compensatory
techniques may be beneficial (i.e was there tongue weakness?
Incoordination? Vocal quality? Airway closure?) This patient may be
able to tolerate normal consistencies with the aid of one or two
compensatory techniques (Chin tuck? Supraglottic swallow?).
The second thing that I am thinking about is that for a person of her
age (91 yrs), pharyngeal residue is not abnormal. So if it is trace
residues in the vallecula then this may not be the key risk factor
contributing to aspiration and you may want to look at other factors
which may help you to address safety with a different approach.
Just some thoughts, hope they are helpful.
Jackie Hummelbrunner, M.Sc. Reg. CASLPO, S-LP (C)
Speech - Language Pathologist
Ont. Ca
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Brad Harvey
Sent: Thursday, January 05, 2006 6:05 AM
To: dysphagia@b9.com
Subject: [Dysphagia] VFSS
I have a question about the interpretation of VFSS. One of my residents
recently had one done that showed residuals on the valleculae with
cookie,
fruit cocktail, thin fluids and thick fluids. Aspiration occurred 2 out
of
3 attempts with thin fluids, none with thick fluids and 1 out of 2
attempts
with fruit cocktail and it was suspect it was the thin fluid component.
The
cookie left residuals, but no observed entry into the airway. No cough
was
observed with the aspirations.
The recommendation was for minced texture with honey thick fluids. The
resident is refusing to eat minced texture and thick fluids. We have
recently changed to already prepared thick fluids and she has agreed to
try
these only after I explained the results of her VFSS and the likelihood
of
aspiration and risk of pneumonia. She is adament that she receive
regular
texture which I have reluctantly agreed to. She is her own POA and she
is
91yo and feels it is a quality of life thing. I have the staff tracking
any
difficulties and discussed appropriate interventions.
Is a digestive cookie not considered minced texture? With residuals
being
left with even thick fluids is there any increased risk providing
regular as
I would think that pureed would be fairly comparable to thick fluids?
Your help is much appreciated,
Brad Harvey, RD
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