Modified Mondays: Miss (or Mr or Ms) Independent
My daughter that just went off to college has always just been one of those independent kids. Typical first born, highly self-motivated, goal setter, did her own laundry at age eight so she would always have the outfit she wanted clean. While this all sounds great on paper, let me tell you that in the toddler years it was a LOT of “NO!!! I can do it MYSELF!!!!”… which in the teen years becomes “Yeah great advice mom, but imma do this other thing instead”... and then “I want to live in Philadelphia, so I am choosing a university seven hours away, see you in November.”
It’s hard sometimes to realize that we can’t always control our kids and make decisions for them. But honestly, that’s the goal, right? We WANT to see them make their own decisions and be independent. That’s normal.
In instrumental assessment, keeping this goal of independence in mind is also really important. SLPs have a tendency to want to feed the patient-it makes it easier for us to catch the image on fluoro, to make sure we have a clear view first on FEES, and then we can also control the bolus size for the protocol (which we should definitely be using). However, this video is a great example of why we would be also allowing the patient to self-feed. In the first swallow of this video, I am feeding the patient from a cup of thin liquid-our protocol includes this-and the patient aspirates before the swallow. I immediately handed the patient the cup, with the same amount and we then progressed through the protocol with the patient taking all other presentations independently with no further issues.
We have evidence that we are more likely to aspiration on the first presentation of a consistency, and also that feeding ourselves results in swallows with improved timing. If you doubt this, next time you’re out to eat, ask your dinner companion to feed you some of your favorite cocktail from a glass. It’s an interesting experience, it can give you a great perspective on your patient’s point of view….and it’s a great party trick if you can master it. Which my daughter is probably trying right now at college. Trying not to think about it too much.
A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease (nih.gov)
MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard (nih.gov)
Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing | SpringerLink