Swallowing the other thing no one thinks Speech Pathologists are into

Yes, we are the ones that do the swallow evaluations that may result in the recommendations of thickening liquids, pureeing foods, or considering a g-tube. Remember, you put 99 therapists in a gymnasium and you'll get 99 different ways to do things. The best I can do is through out some ideas here and please contact me if you have any questions.

Infants need to be introduced to a regular edged cup NOT a sipper cup!!!!

talktools.com has 2 lidded but regular edged cup styles I highly recommend. Amazon.com also has regular edged, lidded cups.
  There are 2 types: one has a regulated flow and the other is a two handled cup for later the child
can use to handle/tip the flow of liquid. 
Playtex has one in drug stores and if you pull out the guts, it becomes free flowing but it is fairly large.

 1. Be sure the cup (even a regular adult cup) is filled to the brim when you are first teaching how to use a cup so they get the idea of touching/kissing the cup edge gets you liquid. You don't have to worry about grading when you have it filled to the brim.

 2. Be sure and start this at 6 months, YES, 6 months, so by 12 months, they have it mastered. 

Call me, 815-541-1857, with any questions.

Reference for Adaptive Equipment www.SammonsPreston.com are now Patterson Medical
and they have all kinds of adaptive feeding equipment. Call them up 800-323-5547and ask them for their catalog (ask for the big all inclusive one so you can see other types of adaptive equipment for bathing, activities of daily living etc...). Things to consider: utensil holder (great for eating utensil, pen, toothbrush holding), one handed bread butter-er, scoop dish, one handed button thingy, bath lift, rocker knife, various cups and no-sip straws. Anyone can purchase items from them; if nothing else use them as a resource to see what has been invented and to comparison shop other websites ie amazon.com or with other vendors.
Aspiration Pneumonia Pneumonia research find that it's poor oral care that provides the bacteria for pneumonia to occur more than it occuring with eating. That is not to say that silent aspiration or overt aspiration with eating can't also be the culprit.
Phlegm Management Sometimes when a person coughs at the beginning of a meal and generally not the rest of the meal (unless they cough throughout the day as well because of underlying medical conditions ie COPD and CHF, etc) it is because they have phlegm buildup because of post nasal drip, sinus problems, nasal cannula oxygen all day, or being a mouth breather. I am a HUGE promoter of lemon water throughout the day. It is a mild astringent that helps prevent a phlegm plug if used throughout the day. It will help get the phlegm plug cut out so it is easier to expel which is helpful when you don't have a lot of stamina/strength to cough. It is vitamin C which all of us could use more of and the green bottle type as well as the fresh fruit type both work however they have different tastes. Put "some" in a cup of water and enjoy! Pretend you are at a fancy restaurant all day. I've got more here on the subject, too.
What goes on with a
Video Swallow test?
Fancy term is 'videofluoroscopy swallow evaluation'. Which is different from a FEES evaluation where they have the camera in your nose and take a look at what your throat looks like before and after a swallow. Remember, the camera blacks out when you are swallowing. Thus I'm not a big proponent of its use in making diet consistency recommendations. We have a person drink and eat items that have barium included so they show up on xray. We have you sit in front of the xray machine in two positions: facing forward and facing to the side. We then try and see if any of the barium tainted consistencies (regular, nectar, and honey consistency liquids, cookie, bread) go down your "Sunday throat". You may (true aspiration) or may not (silent aspiration) necessarily cough if this occurs.
What goes on with a
Clinical or Bedside Swallow Evaluation?
The speech pathologist watches you eat at a prepared meal or has you eat some snack/drink to see if you cough/choke. Suggestions are made in regards to different equipment that may help liquids stay in a stream better through your mouth or utensils that are easier to use to get the food to you mouth or moving your head in different positions to lessen the chances of the food going into your lungs.
How to use a straw I have noticed Speech Pathologists putting "no straws" into their evaluation recommendations and wonder if they even know how to assess straw ability. Sometimes we can prevent having to use thickened liquids in an oral stage dysphagia challenge if we use a straw differently than placing it 3/8 inches past the lips. So, my recommendations sometimes are this: put the straw in the person's mouth mid tongue or further back to drink. If they can't hold the cup/straw themselves.......put tape from the cup, around the straw, to the cup again, so it can't move around so it remains in place and they don't have to chase it around. Then, if they can't hold the cup, you hold it and say "I'm going to leave this in your mouth until I count to 3 and then will pull it out. 1...2...3...out". This way the person can prepare for it to be removed and create the necessary movements for negative pressure to build up and swallow.
I hate thickened water...... add lemon to change the brains thoughts about thickened water. There is research, Frazier Water Protocol, that in certain situations, a person can drink water throughout the day but at meal time, they use the liquid consistency found to be safe when they had their swallow evaluation.
Pleasure Eating Status It's the best of both worlds and I like to suggest it to those that for various reasons such as: low stamina, odds of aspiration increases as the person eats more than a few bites, or can't eat enough to maintain appropriate caloric intake......consider a g-tube to get their "minimum daily requirements" and then it doesn't matter if it takes hours to eat a few bites of jello, you can. This way the loves ones don't have to threaten the poor person that he better eat or else or say they can't have their dessert unless they finish all their mystery meat (that's what I call pureed meat that the nursing home aide hasn't told the person what they are eating). ALWAYS TELL A PERSON WHAT THEY ARE EATING! and if at all possible, as the person to state, point, or reply from a choice what they want placed in their mouth next.
Oromotor Exercises I question the need for some of the tongue wiggling exercises that are suggested by some. From research, I feel that tongue back exercises should include: Masaka (bite your tongue and swallow and feel the back of the tongue stretch), the Shaker (google it, but you lie down and only lift your head, not your shoulders for a number of seconds. I'm not detailing it here), and thinking of words that rhyme with 'king' and hold the /ng/ sound at the end as long as possible. Any questions? Contact me.
Patient's Rights I always say....."I don't care if you want to die eating steak", just let me know your decision so I can document that you have chosen to eat/drink as you wish and understand the complications that may arise from not utilizing the suggestions given to increase your chances of safe oral eating. People have the right to do what they want....that's why people are still smoking even though we know lots of reasons not to do so. You have the right to eat/drink as your wish, too.
Seminar on Feeding


Stages, Symptoms & Reasons for Dysphagia: muscular, neuroanatomical, cognitive, structural, medication induced, relationship to the stages of the swallow, silent aspsiration vs aspiration pneumonia

Evaluation of Swallowing Ability & Design of the Plant of Treatment: How can you be involved? How to communicate the plan of treatment with staff, Utilizing the Speech Pathologist, Bedside & Videofluoroscopy swallow evaluations, Communication's role during the meal, Thermal stimulation, surface EMG biofeedback, & other treatments

Examples of Altered Diet Consistencies: Liquid consistencies & presenting liquids, Solid consistencies & feeding guidelines, Keeping the diet palatable while using the thickeners, Addressing inadequate nutrition, Increasing patient compliance of the diet, Feeding Tube Considerations: options regarding a feeding tube, pleasure eating status & liquid intake while NPO, interventions to use during non-oral feedings

Compensatory Strategies for Each Stage of Swallowing: Body positioning, Adaptive equipment, Diet consistency, Reasons for chin tuck, effortful swallow, supraglottic swallow

Hands-on Mixing with Thickeners for Various Liquid Consistencies: Honey, nectar, pudding consistencies of liquids, What liquids are already these consistencies?

Responsibilities to Assure a Successful Eating Event: Guidelines to share with staff or family that are feeding people, Importance of oral hygiene, Considerations when designing a feeding program, Strategies for impulsive/rapid intake eater, cheek pocketing, straw sucking safety, Involving the person in feeding versus total dependent feeding

Oral Motor Exercises: Specific exercises for various types of dysphagia, Masako maneuver, Shaker exercises & others, Incorporating oral motor exercises with general patient contact

Patient's Rights in Oral & Non-Oral Feedings: Documenting the decision of AMA (against medical advice)

Picky Eater Hints Caloric Densing & Adaptive Equip