1. Think of a recent therapy session or event.
I assessed the swallow of a patient on the stroke unit. The patient had had a previous RMCA and R cerebellar stroke, new left superior cerebellar infarct and left front cortex infarct. She was initially very low arousal but became medically stable.
2. Describe the session/experience
The previous SLT had trialled teaspoons of water and thought that the patient might have aspirated on the second teaspoon. The patient appeared to have weak tongue muscles but was able to cough on command. I trialled the patient on yogurt. Over the next few days the patient managed increasing amounts of yogurt. When she was fatigues the patient would throat clear and cough. I predicted that this may lead to residue build up in her valleculae and clearing coughs/ swallows. The patient was pulling out her NG – feed regularly and the consultant doctor was keen to know if a PEG would be needed for discharge. I asked nursing staff to assist the patient to have yogurt three times a day and to stop when she showed signs of aspiration. My supervisor advised me to trial a puree meal sooner rather than later since the patient had been making quick gains in OT and PT.
3. What did this session make you feel?
I felt that I needed to review my treatment plan more often since the patient was beginning to recover more quickly in other therapies. I needed to consider the patients discharge date more when planning their therapy since she could not be discharged with an NG-feed. Furthermore by getting more practice swallowing the patient is likely to be able to manage more and to transition onto oral feeding.
4. What has this session has taught you?
- To consider the long term goal of swallowing therapy/ dysphagia risks.
- To consider a patients therapy progress in other therapies.
- To balance caution with risk when thinking about maintaining and developing oral intake.
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