My dining room story….
I can’t even count how many times I have started work in a new building or started a new PRN job and been told meal times so that I can go sit with patients during their meals for their therapy time. It’s easy, right. I go sit in the dining room and “observe” 8 patients for signs and symptoms of dysphagia that I’ve already identified and remind patient a to use a chin tuck and patient b to eat at a slower pace.
This is how I learned dysphagia therapy. What was taught to me was to sit with them during the meal to work on trials, observe those trials and remind them to use their strategies. The reality: I tried to do my “job” however Mrs. Smith needed more coffee, could I be a dear and run Mrs. Brooks to the bathroom? I could never do my “job” because I was a waitress. With no tips.
Not only could I not do my “job”, I was not doing anything for those patients! That is not rehabilitation. Look at it this way, if we never stress the system and remain at status quo, how will it improve? If I’m trying to run a 5k, I’m going to push myself to keep going a little further. If I continue to run around the block, I will never build the strength and endurance for a longer run. If we never challenge the swallowing system with a more difficult bolus, then how will my patient upgrade their diet.
Therapy should be…..
Therapy should not be in the dining room. Just like I don’t want a physical therapist to show up in the middle of my meal, our patients don’t want us popping in at their meal time and “working” with them.
Remember, swallowing is a sub-maximal muscle activity. When swallowing, the patient does not use their swallowing muscles to the fullest extent. There may be times that you need to observe and assess a patient but seriously, that shouldn’t happen multiples times a week for multiple weeks.
How is the patient supposed to progress with the therapy if there is never any education, home exercise program or just plain working with the patient.
Let’s challenge our patients and stop just observing!
Logemann, J. A. (1998). Evaluation and Treatment of Swallowing Disorders. Austin, TX: Pro-ed.