Navigating Eating, Drinking and Swallowing in Adults

This book provides an A to Z of eating, drinking and swallowing assessment and management, guiding readers through key aspects, from aetiologies to xerostomia, in 50 top tips. It is an essential resource for all trainee and newly qualified speech and language therapists, as well as more experienced clinicians moving into the field.

Sophie MacKenzie has practised as a speech and language therapist (SLT) in both acute and rehabilitation settings. She began her first academic role in 2007, combining clinical management of the acute SLT team at Maidstone and Tunbridge Wells NHS Trust with teaching at the University of Greenwich and Canterbury Christ Church University. She moved into full-time academia in 2010 and has taught EDS to both undergraduate and postgraduate pre-registration students, as well as post-registration master's students, at City St Georges, University of London. Her PhD focused on exploring spirituality with people with expressive aphasia, and person-centred and holistic care remains her passion, as well as the nurturing of future clinicians. Sophie is the author of Working with Adults with Eating, Drinking and Swallowing Needs and is currently a senior lecturer in SLT at Health Sciences University, UK.

List of abbreviations xv Acknowledgements xviii Introduction xix A 1 Aetiologies 1 Neurogenic 1 Structural 2 Functional 7 Ageing 8 Learning disability and physical disability 8 Anatomy and physiology 8 Key structures 9 Musculature 11 Physiology 12 Oral preparatory stage 12 Oral stage 13 Pharyngeal stage 14 Oesophageal stage 15 Aspiration, laryngeal penetration and choking 15 Aspiration pneumonia 17 B 18 Bolus 18 Buccinator, buccal tension 19 C 21 Cervical auscultation 21 Clinical history 22 Clinical reasoning 22 Judith 25 Prakash 26 Tommy 30 Dervla 30 Clinical swallow examination (CSE) 31 Compensatory strategies 32 Head/body positions 32 Swallow manoeuvres 34 Changes to the environment 35 Helping the person to eat and drink 35 Utensils 36 Texture modification 37 Cranial nerves, cranial nerve assessment (CNA) 37 D 46 Dentition 46 Direct therapy techniques 47 Dysphagia 47 E 54 End-of-life 54 Enteral feeding 55 Epiglottis/epiglottic retroversion 57 F 60 Fibreoptic endoscopic evaluation of swallowing (FEES) 60 G 63 Goal-setting and measuring outcomes 63 H 68 Holistic EDS practice 68 Psychological aspects 69 Social aspects 71 Spiritual/religious aspects 71 Cultural aspects 73 Supporting clients' psychological, social, spiritual/ religious and cultural needs 74 Mitigating the power differential 74 Narrative in EDS needs 75 chaos 76 restitution 76 quest 77 I 79 International Classification of Disability, Functioning and Health (ICF) 79 International Dysphagia Diet Standardisation Initiative (IDDSI) 80 J 83 Joint working 83 Carer 84 Chaplain 84 Client 85 Dietitian 85 Doctor 85 Healthcare assistant 86 Nurse 86 Occupational therapist 87 Pharmacist 87 Physiotherapist 88 Physiotherapist (respiratory) 88 Psychologist 89 Radiologist 89 Radiographer 89 Speech and language therapy assistant 90 Speech and language therapy student 90 K 92 Keep reflecting and learning 92 Reflection 92 Continuing professional development (CPD) 92 Killian's triangle 94 L 95 Larynx 95 Laryngeal anatomy, physiology, function and innervation 95 Laryngeal or hyolaryngeal excursion 97 Laryngeal palpation 97 Hyolaryngeal excursion and treatment options 99 Cough and cough testing 100 M 103 Mastication 103 Medication 103 N 105 Nil by mouth (NBM)/nil per os (NPO) 105 Neurological underpinnings 105 O 109 Odynophagia 109 Oral hygiene, oral examination and oral care 109 P 112 Positioning 112 Presbyphagia 114 Osteophytes 114 Pulse oximetry 116 Q 118 Questions to ask the client and carer (case history) 118 R 122 Residue 122 Oral residue 122 Pharyngeal residue 123 Risk 124 S 126 Session planning 126 T 129 Tastes for pleasure 129 Three tenets of EDS management 129 Tracheostomy 130 Description 00 Effect on swallowing 00 Decannulation 133 EDS assessment 134 EDS management 136 Key differences between tracheostomy and laryngectomy 137 U 138 Uvula 138 V 140 Videofluoroscopy (VF) 140 What is it? 140 What happens during the procedure? 140 Why might you refer a client? 143 Pros and cons 144 Personnel 145 Consent 145 Safety considerations 146 Writing the report 147 W 148 Water - protocols and tests 148 Frazier Free Water Protocol 148 Timed Water Swallow Test (TW ST) 149 X 151 Xerostomia, sialorrhoea and salivation 151 Xerostomia 152 Sialorrhoea 153 Y 155 Yoghurt 155 Your supervision and support 155 Z 157 Zoom or EDS assessment and management via teleheath 157 Appendix 160 References 175 Index 181