Learning disability and dysphagia

Here is some information i have summarised from the latest RCSLT guidelines on dysphagia in the learning disability population (Wright, D et al 2013).

Learning Disability is defined as a significantly reduced ability to understand new or complex information, to learn new skills and to cope independently.

Discuss eating and drinking with the patients carer and ideally observe them at mealtimes (they may be unable to communicate effectively).

Food Modification

The British Dietetic Association recommends a hierarchy of textures according to need: Fork- mashable diet, pre-mashed diet, thick puree, and thin puree. The type of food texture required is dependent on the oro-motor and swallowing needs of the patient.

Thickeners can be used to reduce the risk of aspiration since they help the patient form a cohesive bolus, thus aiding oropharyngeal control and slowing transit time in the pharynx. However supporting evidence is limited and thickeners affect food palatability, compliance can be an issue, hydration is often negatively affected and there is still a risk of aspiration pneumonia.

Postural techniques to support swallowing

Often need good cognition/ memory e.g. the Mendelsohn manoeuvre, tongue hold technique, and the double swallow.

Swallowing therapy

Independence during mealtimes can enable a person with learning disabilities to control the speed and pace of a meal and therefore to clear the oral cavity before the next mouthful. Hand over hand facilitation can maximise independence.

It is important to involve patients and their carers in care planning and management. Non-compliance by patients/ carers is common. Patients with LD may find it hard to understand the implications of their swallowing difficulties. It is therefore important to communicate to carers the need to follow swallow recommendations in order to reduce the risk of aspiration.

Care Plans

Written care plans are best.They should include eating, drinking and swallowing guidelines and mealtime information forms. Care plans should be individualised, and outline the patients needs, make clear the actions needed to achieve the goals and to evaluate the management process. Care plans should be reviewed regularly.

Monitoring

Patients requiring puree diets/-thickened fluids  are at high risk of developing malnutrition/ dehydration which in turn can negatively affect swallowing. Malnutrition causes fatigue, muscle weakness and impaired coughing, while dehydration reduces the fluid content of saliva.

Carers of patients on puree/ thickened fluids need to encourage their clients to eat/ drink small amounts of food (high energy)/ fluid throughout the day.

Duty of care

We are legally obliged to provide evidence based care and treatment tailored to the individual.