College Dorms and Dysphagia Assessment: Sometimes you can’t know until you get there
We are getting ready to take our first child off to college soon, and we were in the midst of frantic purchasing for all conceivable situations (Gah! You need a first aid kit!! A toilet brush! A container for dirty shoes!) when I found out that (duh!) Amazon delivers right to her dorm door. Suddenly I realized that we really didn’t know what size containers she needed for under the bed, or what shade of moon and stars tapestry would look best-because we haven’t really seen the space yet (she’s going to school out of state and thanks to the pandemic we never got to see the dorms in person). We could end up buying a whole lot of stuff she didn’t need, or stuff she did need-but in the wrong size or (heaven forbid) color. We decided then to just get some basics to start off with, and once we see the actual room we can decide from there what will work best.
When using strategies to short term compensate for dysphagia, the concept is the same. You really don’t know what is going to work until you see it in person. Without the visual provided by instrumental assessment, we run the risk of recommending a strategy that doesn’t match up with the actual impairment, or even increases the severity of the aspiration or residues. The chin tuck with this patient is a perfect example. The patient here has incomplete airway closure and incomplete pharyngeal contraction during the swallow. With thin, the chin tuck was highly effective-but with nectar, the chin tuck actually increased the severity of the penetration and aspiration for that consistency. Research evidence tells us that the effectiveness of the chin tuck is highly variable and dependent upon many things, including the severity of the dysphagia and the viscosity of the bolus assessed. It’s just not something you can figure out without seeing it happen.
In dysphagia assessment, it’s important to have evidence before recommending a strategy or plan of care. Just like in taking your child off to college, it’s crucial to have a box of tissues for the drive back home. (Already purchased and packed)