Speech pathology is one of many disability support services we offer at The Benevolent Society. Despite the name, did you know a speech pathologist does more than assist people with a communication impairment?
We speak to Rachel, one of our Senior Speech Pathologists, who tells us about how she is supporting people living with dysphagia.
What is dysphagia?
Dysphagia is a condition where a person has difficulty swallowing. We swallow around 500 – 700 times a day, so it’s very important that we swallow correctly to ensure that no food, drink or saliva enter the lungs which can cause infection and pneumonia.
Associated with a wide range of disabilities and health conditions, the risk of dysphagia increases as a person gets older.
“As a speech pathologist, our goal when working with a person who presents with dysphagia is to ensure that they remain safe during all oral intake of food, fluids or medication,” explains Rachel. “We also provide basic training and skills to the family members or carers so they can assist their loved one during mealtimes.”
When Rachel meets a new client with dysphagia, she completes a comprehensive mealtime assessment that includes their current eating and drinking skills. She evaluates the client at each stage of swallowing and also looks at how behaviour, environment and communication might be impacting their condition.
“When it comes to dysphagia, every individual’s needs are different and may require input from a multidisciplinary team. I often work collaboratively with a dietitian who provides dietary input and an occupational therapist who covers positioning and utensils recommendations when required,” says Rachel. “The three of us are highly specialised in what we do. Dysphagia impacts clients differently in multiple areas, so our integrated approach helps a client to live independently, reduce the negative impacts of dysphagia and improve their individual safety and quality of life.”
Treatment strategies that Rachel and her colleagues take include modifying a person’s mealtime routine, modifying food texture and providing education and training to family members or caregivers to ensure the person they are supporting remains safe during mealtimes.
All about texture modification
One of the treatments that Rachel employs is a texture modified diet. These are diets where the texture has been modified to make it safe for consumption for individuals with swallowing difficulties. The International Dysphagia Diet Standardisation Initiative is a resource that clinicians use to ensure that the foods recommended fit the meal plan for their patient.
Pureeing foods is a common texture modification, but for many clients it can be unappealing, particularly with foods where appearances can be a big part of the appeal, such as a steak dinner.
“There are a couple of ways we help individuals accept the change in texture modification,” explains Rachel. “Pureed diets can be moulded with a special powder that solidifies the food to resemble the unmodified meal. This maintains the look of the meal, but the pureed texture remains intact and is therefore safe for eating.”
A minced moist diet is another texture modification used as a treatment for dysphagia. These are diets that include foods that are soft, moist and do not contain any hard or sharp lumps. Some fully prepared meals already fit within the scope for this and can be used to ease people into a texture modified diet.
Rachel tells us that shepherd’s pie is one such example. “I can serve this to a client, and they might not realise that the meal has been prepared under the guidelines of their recommended texture modification.”
Some foods can be tricky to incorporate into a texture modified diet. Foods classified as mixed consistency, or dual consistency, incorporate both solids and liquids and can pose a risk to clients with dysphagia. Common foods might be cereal with milk, but many fruits also fit this category including watermelon, mandarins and grapes.
Other foods that are hard to incorporate are transitional foods, which start as one texture but change into another when eaten. A wafer starts off brittle but as saliva is introduced during eating, the texture changes and can pose a risk for those with dysphagia.
“These food types pose a risk of choking as a person may not have the skills to manage both consistencies or changing textures. It’s important when developing a meal plan to ensure foods fit within the scope of an individual’s dysphagia requirements. Personal preference can also influence what goes into a meal plan,” says Rachel.
A person centred approach to care
Rachel encourages speech pathologists in this space to take on a person-centred approach that acknowledges a person’s likes and dislikes.
“Food is such a central part of living,” she says. “We love spending time with family and friends over a meal. It goes beyond sustenance; we eat for joy and connection.”
Rachel recalls working with a client in supported accommodation who experienced a challenging time accepting that her food needed to be texture modified to keep her safe after developing dysphagia.
“She was placed on a minced moist diet and didn’t like the look of her meals in comparison to the other clients she was living with. She was known to refuse meals or would take food and hide it without staff realising.”
Working with support staff to understand what foods the person liked and disliked, Rachel suggested they prepare meals that already fit within the criteria of minced and moist diets, such as shepard's pie, meatloaf with gravy, lasagne and scrambled eggs.
Over the course of several months, there was an improvement to the clients' attitude towards mealtimes. Acknowledging and addressing the reasons why she disliked her minced moist diet and preparing meals that fit the criteria of her treatment whilst still maintaining her dignity allowed her to continue to receive treatment and experience improvements in her condition.
If you, or someone you know would benefit from a speech pathology service please visit our page here or call our friendly support team on 1800 236 762.