Now that we have been sharing Modified Mondays for a year, I thought I would revisit my favorite topic - the normal swallow. As students, we often get so little exposure to what normal swallow physiology can/should look like (no fault to the universities-there is just not enough time in the curriculum for all the swallowing things), and as practicing clinicians we get minimal exposure to normal swallowing in instrumental assessment. Speaking of exposure… this week’s video clip actually features me swallowing multiple consistencies.
You will see collection of the bolus into the valleculae and pyriforms, less mastication than you should (apologies to my parents, I swear they taught me manners), talking while eating (no audio), penetration a couple of times, and if you watch carefully-aspiration. All me, all normal. Just wanted to take a special moment to once again drive home that the data we collect during an instrumental assessment needs to be examined with a critical eye and weighed against what we know about the patient. In this case, a relatively healthy (although mildly overstressed) individual with no prior history of respiratory distress, choking or pneumonia, albeit with a somewhat small epiglottis.
Yes, I aspirated on thin. Do I automatically need intervention or therapy? Nope. (Well no therapy for my swallowing anyway…) When assessing patient’s during instrumental assessment, we cannot make decisions based on that data alone, but need to weigh the full measure of a patient to develop a plan of care.
On a side note, thank you for all the views, shares, messages, and comments on our Modified Mondays! We are happy to share these with all of you!
Final note, please no comments on my small epiglottis, I’m a little sensitive about it!