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[Dysphagia] Logemann results
> Dear Irene and list,
>
> Thanks as always for pointing us to the literature. I was initially
> surprised that I had missed such an interesting finding (that "thickened
> fluids are aspirated, the thicker more than the thinner") in a review of the
> literature I am writing. So...I went back to this article, and re-read it.
>
> I am the first to say I may be wrong (about many things!) and I have no
> wish to engage in a discussion of the merits of thickener (I am not a fan,
> particularly), but I do believe that the Perlman, et al. (2004) article does
> not necessarily fully support your statement. If I am misinterpreting this
> article, or your statement, I would be glad for gentle guidance -- but
> here's my go at it :-):
>
> Perlman and colleagues examined the relative likelihood of patients with
> and without sensory (per FEESST, based on elicitation of the laryngeal
> adductor reflex to air puff) and motor (defined as reduced pharyngeal
> squeeze) deficits to aspirate pureed foods. They did not report on any fluid
> consistencies - in this study -- for comparison. They did refer to other
> studies that suggested that sensory deficits are highly correlated with
> aspiration on thinner fluids.
>
> In their conclusions, they wrote (the italics are mine) : "It appears from
> these studies that the motor component of the swallow is more important
> than sensation when administrating a pureed diet and the sensory componentis more important for the safe consumption of thin liquids. The clinical
> implication of these findings is that persons with an intact squeeze should
> be able to consume pureed food."
>
> My interpretation of these findings is that they remind us primarily that
> our job is to assess the sensory and motor function of our patients, using
> whatever methods are appropriate, and that we understand the physiology of
> the swallow relative to the foods and liquids we provide, the cognitive and
> emotional state of the patient, and the environmental and cultural issues (
> e.g. dietary preferences) in each case.
>
> Best regards,
>
> Kate Krival M.S. CCC-SLP
> Doctoral Candidate
> Communication Sciences and Disorders
> University of Cincinnati
>
>
> On 5/11/07, Irene Campbell-Taylor <eripley at yahoo.com> wrote:
> >
> >
> >
> > Rob Melchionna <robmelch70 at hotmail.com>
> > wrote: P { margin:0px; padding:0px } body { FONT-SIZE:
> > 10pt; FONT-FAMILY:Tahoma }
> > "thickened fluids are aspirated, the thicker more than the thinner (as
> > Perlman proved years ago)"
> > Can you clarify that for us? I've never heard that before.
> >
> >
> > Perlman PW; Cohen MA; Setzen M; Belafsky PC; Guss J; Mattucci KF;
> > Ditkoff M The risk of aspiration of pureed food as determined by flexible
> > endoscopic evaluation of swallowing with sensory testing. Otolaryngol Head
> > Neck Surg 2004 ;130:80-3
> > Patients with impaired pharyngeal squeeze at different levels of
> > sensory deficits are at significantly greater risk for aspiration of pureed
> > foods?.. Dysphagic patients who are given a pureed diet to prevent
> > aspiration may still be at risk for aspiration.
> > Also,
> > "the almost universl belief that thickening prevents aspiration"
> >
> > Where did that come from? Do you mean among SLPs? Nurses? MDs? I really
> > don't think this is the case anymore...
> > *** I'm surprised that you are surprised. I have been excoriated
> > repeatedly for suggesting that thickening does not prevent aspiration as the
> > archives of this list will show. There is a multi-million dollar business
> > now operating on the assumption - transmitted to patients and families -
> > that that thickening is essential to preent aspiration. In fact a recent
> > message on this list clearly implied exactly that. I sincerely wish that it
> > becomes NOT the case any more.
> > Irene
> >
> >
> >
> >
> >
> > ---------------------------------
> > > Date: Wed, 9 May 2007 15:45:05 -0700
> > > From: eripley at yahoo.com
> > > To: Wilma.Clancy at cdha.nshealth.ca; dysphagia at b9.com
> > > Subject: [Dysphagia] Logemann results
> > >
> > > These are the patients most often found in LTC ? and the Parkinson's
> > with dementia is actually the parkinsonian stage of dementing illness. I
> > don't believe anyone has made general statements about all dysphagic
> > patients ? simply that, contrary to popular belief, thickened fluids are
> > aspirated, the thicker more than the thinner (as Perlman proved years ago),
> > and, as the authors say, it is probable that the lungs' ciliary motion
> > cannot clear the gum-based thickener used. If so, this would apply to all
> > since lung function is not affected by dementing illness.
> > > The importance of the findings is mainly to point out that the almost
> > universl belief that thickening prevents aspiration is false and that
> > dehydration is a constant danger.
> > >
> > > Dr I Campbell-Taylor
> > > Clinical Neuroscientist
> > > Exclusive Distributor:
> > > www.interactivetherapy.com
> > > _______________________________________________
> > > Dysphagia mail list: Normal and disordered swallowing information
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> >
> >
> > ---------------------------------
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> >
> >
> > Dr I Campbell-Taylor
> > Clinical Neuroscientist
> > Exclusive Distributor:
> > www.interactivetherapy.com
> > _______________________________________________
> > Dysphagia mail list: Normal and disordered swallowing information
> > Dysphagia at dysphagia.com
> > Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> > Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
> >
>
>
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