Navigating Eating, Drinking and Swallowing in Adults

List of abbreviations xv

Acknowledgements xviii

Introduction xix

A 1

Aetiologies 1

Neurogenic 1

Structural 2

Functional 7

Ageing 8

Learning disability and physical disability 8

Anatomy and physiology 8

Key structures 9

Musculature 11

Physiology 12

Oral preparatory stage 12

Oral stage 13

Pharyngeal stage 14

Oesophageal stage 15

Aspiration, laryngeal penetration and choking 15

Aspiration pneumonia 17

B 18

Bolus 18

Buccinator, buccal tension 19

C 21

Cervical auscultation 21

Clinical history 22

Clinical reasoning 22

Judith 25

Prakash 26

Tommy 30

Dervla 30

Clinical swallow examination (CSE) 31

Compensatory strategies 32

Head/body positions 32

Swallow manoeuvres 34

Changes to the environment 35

Helping the person to eat and drink 35

Utensils 36

Texture modification 37

Cranial nerves, cranial nerve assessment (CNA) 37

D 46

Dentition 46

Direct therapy techniques 47

Dysphagia 47

E 54

End-of-life 54

Enteral feeding 55

Epiglottis/epiglottic retroversion 57

F 60

Fibreoptic endoscopic evaluation of swallowing (FEES) 60

G 63

Goal-setting and measuring outcomes 63

H 68

Holistic EDS practice 68

Psychological aspects 69

Social aspects 71

Spiritual/religious aspects 71

Cultural aspects 73

Supporting clients' psychological, social,

spiritual/ religious and cultural needs 74

Mitigating the power differential 74

Narrative in EDS needs 75

chaos 76

restitution 76

quest 77

I 79

International Classification of Disability,

Functioning and Health (ICF) 79

International Dysphagia Diet Standardisation

Initiative (IDDSI) 80

J 83

Joint working 83

Carer 84

Chaplain 84

Client 85

Dietitian 85

Doctor 85

Healthcare assistant 86

Nurse 86

Occupational therapist 87

Pharmacist 87

Physiotherapist 88

Physiotherapist (respiratory) 88

Psychologist 89

Radiologist 89

Radiographer 89

Speech and language therapy assistant 90

Speech and language therapy student 90

K 92

Keep reflecting and learning 92

Reflection 92

Continuing professional development (CPD) 92

Killian's triangle 94

L 95

Larynx 95

Laryngeal anatomy, physiology, function

and innervation 95

Laryngeal or hyolaryngeal excursion 97

Laryngeal palpation 97

Hyolaryngeal excursion and treatment options 99

Cough and cough testing 100

M 103

Mastication 103

Medication 103

N 105

Nil by mouth (NBM)/nil per os (NPO) 105

Neurological underpinnings 105

O 109

Odynophagia 109

Oral hygiene, oral examination and oral care 109

P 112

Positioning 112

Presbyphagia 114

Osteophytes 114

Pulse oximetry 116

Q 118

Questions to ask the client and carer (case history) 118

R 122

Residue 122

Oral residue 122

Pharyngeal residue 123

Risk 124

S 126

Session planning 126

T 129

Tastes for pleasure 129

Three tenets of EDS management 129

Tracheostomy 130

Description 00

Effect on swallowing 00

Decannulation 133

EDS assessment 134

EDS management 136

Key differences between tracheostomy and

laryngectomy 137

U 138

Uvula 138

V 140

Videofluoroscopy (VF) 140

What is it? 140

What happens during the procedure? 140

Why might you refer a client? 143

Pros and cons 144

Personnel 145

Consent 145

Safety considerations 146

Writing the report 147

W 148

Water - protocols and tests 148

Frazier Free Water Protocol 148

Timed Water Swallow Test (TW ST) 149

X 151

Xerostomia, sialorrhoea and salivation 151

Xerostomia 152

Sialorrhoea 153

Y 155

Yoghurt 155

Your supervision and support 155

Z 157

Zoom or EDS assessment and management

via teleheath 157

Appendix 160

References 175

Index 181