[Dysphagia] Conditioned dysphagia

[mbuckie at dmc.org (Buckie,Marcia)]

For those of you in the Midwest, I just received a flier offer Dr.
Toomey's SOS course in the Metro Detroit area.

Marcia

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Pat Burns
Sent: Thursday, December 21, 2006 21:11
To: dysphagia at b9.com
Subject: [Dysphagia] Conditioned dysphagia

Hello Dale,

This is not an uncommon condition in the population that I treat - birth
to 
5.  Most of my kids have an intact swallow  but the sensory ,
mechanical, 
gut,  or the poor learning experiences with eating because of these
issues, 
are the problem.   The variations in food acceptance across texture are
not 
at all uncommon after a choking event.

All thoughts that follow are based on the Sequential Oral Sensory
feeding 
protocol developed by Kay Toomey Ph.D.  (Toomey and Associates Denver,
Co) 
If you work with children or adolescents I highly recommend her
trainings. 
SOS is absolutely the most "behavioral" feeding protocol I have ever 
learned- and the absolute opposite of the traditional
" behavior" programs, and it works ( better, faster and more rational!)

The program I would use with this young man would be a variation of Dr. 
Toomey's "Food Scientist " protocol.

 I will provide some general thoughts-but there is nothing like training

with Dr. Toomey for developing a treatment protocol for a kid like this.

 Look carefully at the mechanics of the chew.  This child could be 
overstuffing because of poor motor control -  if he puts enough food in
his 
mouth- eventually something will hit the teeth and get masticated! In
other 
words was this kid a choking event waiting to happen?

Think about sensory awareness in the mouth.  I suspect because of the 
anxiety and ADHD you mentioned that this young man may have a problem
with 
the sensory area.  The mechanics are ok, but the feedback and awareness
are 
off.

 No matter what I did to treat the underlying cause of the choking
event, my 
treatment program would include a lot of food exploration with the other

senses- how does it look, feel, smell, what happens when I smash it with
my 
hand?   I would  do a ton of work across all 6 food textures with a lot
of 
chewing and spitting out and evaluating the size of the masticated
pieces 
against swallowable pieces. Also evaluation the size of the "bites"
because 
I suspect there might be overstuffing.  Give graphic representations.
Show 
the size of a bolus that will go through easily- and the size of a "to
big 
bolus"  don't worry about segmental swallowing- you are teaching control
and 
reducing anxiety about choking. I am talking about drawing a "swallow
sized" 
circle,  taking a bite, chewing it spitting it out and evaluating -is
this 
too big, too small or just right to swallow.  And how small are those
chewed 
pieces? If I chew 10 times and he chews 10 times are the size of the 
masticated pieces the same?  It is gross-- but boy does it work.

 Talk and learn about food in terms of its inherent properties.  Bring
the 
cognitive into the picture. Start with accepted foods and find foods
that 
are similar but not exact in properties.  Praise, praise every
interaction 
with any non preferred food.

If you treat a varied and  non dysphagic non eaters- SOS is the training
you 
want!

Also, Dr. Toomey's office can refer you to a therapist trained in this 
methodology in your area, and you can refer this young man to that 
practitioner.

Hope this helps

Pat Burns


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