Speech therapy and feeding…geriatrics…occupational therapy…
We recently had a speech therapist who works at a local rehab hospital come in to talk to us about speech therapy and geriatrics. She talked about (and all the following is just my own, possibly wrong, understanding) how there are three major domains – cognition, communication, and dysphagia.
Cognition – a lot of overlap with OT
Communication – verbal expression, comprehension, voice, etc
Dysphagia – swallowing issues
Some of the cool things we learned about:
- The Passy-Muir speaking valve is used on the ends of trache’s to help some people speak, and it’s just a little cap thing that costs a few hundred dollars. Insurance usually covers it.
- Dysarthria is slurred speech – slow, loud, overarticulate
- We/they should look at the person’s face for nonverbal cues and/or lipreading
- Amonia is trying to find the right word an it’s a type of aphasia (the whole Wernicke’s & Broca stuff)
- Receptive aphasia – trouble understanding
- Expressive aphasia – trouble sharing information (on one of my fieldworks, there was a young girl who had a stroke and had this – she couldn’t figure out how to speak except to say “Toaster Strudel”, which was her favorite food).
- People may have difficulty manipulating the bolus (the food) or forming the bolus, which is an oral issue, due to perhaps lip weakness or limited tongue movement
- People may show signs of aspiration such as coughing, which means food is going down the wrong tube, so to speak. Modified barium swallows can help find if this in fact happening
- People who do have problems with aspiration may need to be on thickened liquids – there is a powder you can use to thicken water, even. Gross!
- OTs/Speech can give tips like clearing out the throat, swallowing twice after each bite, and pointing out “pocketing” in the mouth where the person doesn’t realize they still have food in their mouth…perhaps due to a stroke, or because of Parkinson’s, etc.
I’ve also been in contact with an anonymous OTR/L who told me about her pet peeves with feeding. The following is a copy/paste from her e-mail, after I asked her about it.
I am glad you asked about the techniques with feeding. Next time you are at the nursing home if it’s close to a meal stay and observe. even for 5 minutes. OH OH where do I start…
.Before the meal some staff walk around and say here Mrs. Smith here is a bib and put it on, or worse; don’t say anything and just put it on. An OT would say Mrs Smith would you like me to help you put on an apron we are having spaghetti and sauce or some thing like that. We look at how they are positioned at the table, do we need a special chair, cushion, special table. We are big time into equipment, but keep it looking as close to “Normal”. that can be a challenge. Hygiene at meal time is so important, some staff go from patient to patient without changing gloves,or washing hands that drove me crazy. Karen there is so much more I will just say a little more and then see if you notice anything, good or bad. Some staff just scoop a big pile of food and put it in,from the side of the patient, the patient gets startled and nearly chokes. A good OT like you would say Mrs. Smith what would you like next, the salad, bread or meatball?
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