Reflective log14.05.13: low arousal- oral desensitisation program

1. Think of a recent therapy session or event.

I had a 104 year old client with a large LMCA stroke who was very low arousal. Her family were keen for her to have oral trials/ a swallow assessment but she was unable to follow instructions or to functionally communicate and was not alert enough to be safe for a swallow assessment. I completed the WHIM with her while giving her mouthcare/ in joint OT sessions. Initially the patient did not like the oral sponges so I used a toothbrush instead and hand over hand facilitation.

2. Describe the session/experience

I developed an oral desensitisation program for the patient which her family could complete with her. My rationale was that she was refusing mouthcare (tuning her head and closing her lips). If she would engage with mouthcare perhaps she could then progress onto oral trials/ a swallow assessment. Furthermore her family would have a concrete task that they could use to interact with her.

3. What did this session make you feel?

I felt like I was able to handover a useful task for the patients family to do with her, which would make them feel more useful and feel like we were a team.

4. What would you want to change, and why?

I would have considered the oral desensitisation program earlier in her admission and considered how I could engage the patients family in her rehabilitation goals/ how to give them information.

5. What has this session has taught you?

I have learnt that I need to prepare information and tasks for patients’ families so that they can feel empowered and part of the therapeutic process.

6. What do you need to learn or find out before the next event?

- Research desensitisation.

Oral desensitisation program

• ·      Using a dry soft cloth gently massage the patients lower face, on both sides, starting with his nose and moving over his cheeks, jaw, chin and lips. Wipe the cloth around his lips gently. Be careful not to put your fingers in his mouth as he may bite you.
• ·      Repeat the massage using a cold wet cloth.
• ·      Using a mouthcare sponge moistened with room temperature water, wipe around the inside of the patients mouth and around their teeth (on both sides, top and bottom).
• ·      Wipe the sponge along his hard palate, being careful not to go too far back in his mouth.
• ·      Wipe the sponge along his tongue, from back to front and along the sides.
• ·      Repeat the last 3 steps with a sponge dipped in ice water and a sponge dipped in a flavoured liquid e.g. squash.
• ·      Make a note of how well the patient can tolerate each stage, whether she is biting on the sponge, whether she swallows any of her saliva and whether there is any coughing or shortness of breath.