- Lead therapist - directed, decided on consistencies/ repetitions.
- Treating therapist - fed the patient, made up the barium coated food, stated when ready to start recording, advised on strategies to use/ what the client is like at baseline.
- Explanations - Process was explained clearly for the patient + what they needed to do (sit in position + eat/ drink normally when asked to). Given rationale, talked through anatomy, offer given to go through the video afterwards.
Notes
- Swallow attempt, consistency and amount.
- Symptoms observed e.g. overspill, delay, residue - where/when/how much.
- Disorder e.g. reduced BOT - PPW approximation.
- Aspiration/ penetration scale.
- No. of swallows to clear.
Watching the video
- It was useful talking through my thinking with the lead therapist.
- The focus was on aspiration/penetration and then worked backwards from there to consider the reason for aspiration.
- The video's are normally replayed repeatedly on a separate occasion when writing the report.
Mini - report
Client
- Right subdural haematoma, recent hospital acquired chest infection ?silent aspiration.
- Currently eating a soft diet and drinking thin fluids.
Oral stage
- Slow prolonged oral stage when eating soft foods requiring chewing.
- Effortful chewing and bolus transfer.
- Difficulties initiating a swallow when swallowing teaspoons of water. Delayed swallow trigger with overspill into the valleculae. Able to trigger a swallow quicker when cup drinking.
Pharyngeal Stage
- Delayed pharyngeal swallow trigger.
- Overspill of bolus' into the valleculae on both soft food and liquids. Penetration observed at the level of the valleculae.
- No cough reflex triggered in response to residue.
- Clearing swallow cleared all of the residue.
Strategies
- Clearing swallow was successful.
Conclusion
- Mild oro-pharyngeal dysphagia characterised by reduced oropharyngeal sensation leading to a bolus overspill and a delayed swallow trigger. Risk of silent aspiration. No aspiration when the patient ate/drank slowly and used clearing swallows.
Recommendations:
- Soft diet, Normal fluids (clearing swallows, slow drinking, monitor chest status).
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