My number one rule-of-thumb, especially when treating my patients with dysphagia is to put myself in their shoes. I must consider their goals and wishes as well as their understanding of dysphagia and how that impacts their therapy. Swallowing assessment and therapy is very much dependent on how well you can explain what you are doing with your patient.
First, I need to make this patient and their family member understand just what is going on. No, I don’t explain dysphagia in medical terms, but it is easy to put into layman’s terms when you understand the swallowing process. The patient needs to understand dysphagia, what is compromising their swallowing function and understand how and why dysphagia treatment will make them better and safer. Patients need to understand that this can be a life-threatening dysfunction but that it can be improved through therapy, diet modifications, compensations, etc. Patients should also not be scared or bullied into thinking that one instance of aspiration will immediately kill them.
One of the joys in life is eating. We all go through our day eating and drinking. It’s how we socialize, what we do at holidays. Our patients do not want to continue on a pureed diet with honey thick liquids when there is therapy available to possibly get them to a higher level. I’ve seen too many people discharged from therapy on an altered diet because the therapist has no idea what to do with them. I’ve also seen patients upgraded before they even really have therapy. Upgraded three days after the MBSS with severe dysphagia and aspiration may not bean appropriate upgrade.
Remember that our job as dysphagia therapists is to rehabilitate, or bring about change to the swallowing system and the musculature of the swallowing system. We cannot bring about change by sitting with a patient during lunch and reminding them to tuck their chin. We cannot bring about a change by having them stick out their tongue 30 times a day and think that’s going to improve the swallow. The only true exercise for the swallowing system is swallowing and challenging the patient with the swallow.
Not every patient is looking for rehabilitation. Some may decide to forego the therapy. If they do so after your education, that is ok and that is their choice. Much like they may not take a medication the doctor has prescribed, they cannot be forced into therapy.
You can read more about assessment, exercise and outcome measures to add to your assessment and treatment. Outcome measures can often be completed as a patient survey and can give you great insight into the person’s understanding of dysphagia and the impact it has on their life.