[Dysphagia] Flexible thinking

[eripley at yahoo.com (Irene Campbell-Taylor)]

 The writer says that it is hard to maintain hydration with sips or teaspoon. Indeed it is and teaspoons are the worst means of feeding anyone ? how?s that for a blanket rule? Anyone ever tried it? Please do and you?ll see what I mean. More importantly, it has been repeatedly shown by Logemann, Kahrilas and others that the larger the bolus the more efficient the swallow.
  I.V. for chronic hydration? Never. But clysis is used widely for exactly that ? don?t know why the US is so far behind the rest of the world. Medicare even has a code for payment.
  Flexible thinking? Would that it happened. I can?t say that I see much of it however desirable it may be but there are some blanket rules in medicine whether we like it or not. 
  The clinical examination is, in my experience, almost never taught or taught incorrectly ? no cranial nerve assessment, belief that tongue movements outside the mouth have anything to do with swallowing when they don?t, no assessment of the brain stem, belief that a ?wet voice? means aspiration when it doesn?t and on and on. It?s not for nothing that every study ever done of agreement between SLPs on swallowing assessment and treatment has shown that there is none. 


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com