Navigating Eating, Drinking and Swallowing in Adults

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