The inspiration for this week’s Modified Monday comes from the viral video of the little boy talking to Linda about cupcakes My 3 year old must argue and debate everything! - YouTube. If you’ve never seen it, it’s a must watch. All we want Linda to do is listen! :)
There once was a DON, we’ll call her Linda. Linda refused to ok an MBSS for a patient who was NPO because, to her, he looked as though he wasn’t going to be able to “pass” a swallow test. The patient had a gun shot wound to the face, resulting in him having a jaw fixator, poor articulation, and a trach. He also had his jaw wired shut, but the wire was removed 8 weeks ago at the hospital. The patient was in his young 20’s, healthy, and enjoyed walking around the facility and chatting with other patients. He had been asking for over a month for some Coca Cola and pizza. The entire time, the SLP persevered to try to get Linda to change her mind and agree to request the order from the doctor (in this facility, only the DON contacts the doctor for instrumental swallow evals). Finally, 8 weeks in…Linda requested the order from the doctor and the order was placed.
Today’s Modified Monday is a perfect example of why facilities should follow the recommendations of those who know the most about swallowing…SLPs. In our video clip, the patient started off with liquids, and while he presented with decreased bolus control and oral residue, he had a perfectly functional pharyngeal swallow. As the patient continued through the test, a cookie was assessed as well. Knowing the patient’s jaw and oral limitations, the cookie was presented in only a small amount (1/4 of a Lornadoone) and broken up. He was able to masticate, but it was prolonged due to his limited jaw movement. The patient also had lingual limitations as well, which resulted in frequent anterior oral residue. He was able to clear this with a cue to suck/swallow to move the remainder of the bolus to the back of his oral cavity. Was it a perfect swallow? Definitely not, but thin liquids and a minced and moist diet were recommended, in addition to regular foods for pleasure if they were broken into very small pieces and given as small bites.
Linda was ecstatically surprised and the first to get the patient some Coca Cola and pizza. Linda is now confident in the SLPs abilities and requests MBSs from the MD when they are recommended. Linda is listening.