When most patients are admitted to Rockcastle Regional, they are already experiencing some degree of dysphagia, or difficulty swallowing.
Sometimes, they’ve been on a feeding tube for months.
“The muscles in their throats aren’t doing what they are supposed to do,” said speech pathologist Brandy Cable.
The effect can be traumatic.
Not only are nutritional challenges presented, but quality of life suffers as well.
The act of eating and drinking is a simple joy often taken for granted.
“People don’t know how it is not to be able to eat unless they’ve been through it,” said patient Martha Hale as she underwent therapy in Rockcastle’s inpatient rehabilitation room.
That’s why Rockcastle has a team of speech pathologists who spend much of their time helping patients regain the ability to swallow.
“The ability to swallow and eat has such a big effect on daily life,” Cable said.
Upon arrival, Cable or the other inpatient speech pathologist, Amanda Hale, use an endoscope to perform what’s known as a Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Many long-term care facilities contract out the highly technical study, but at Rockcastle it’s performed by its own in-house team.
“That test is key,” said Cable, noting that unlike other studies such as the modified barium swallow test, the FEES can be taken to bedside, which makes it easier for the patient.
Once evaluated, about 75 percent of patients will receive therapy, which might include efforts to strengthen the base of the tongue, increase laryngeal elevation or improve the timing of the swallow.
Swallowing is a complex physiological process powered by muscles in the throat and tongue. Those muscles have to be strengthened, and speech pathologists work with the patient to strengthen them much the same way a physical therapist might work to help a patient rebuild muscle function in an injured arm.
“You want them to have as much functionality as possible on the least restrictive diet possible,” Cable said.
The stakes are high. If a patient who isn’t ready attempts to swallow certain kinds of food, the result can be pulmonary aspiration, meaning the food goes down the respiratory tract instead of the gastrointestinal tract, putting them at risk for respiratory complications.
Patients are carefully monitored.
Speech pathologists work in tandem with dietitians and food services to make sure patients get the appropriate food. Texture is the key. While some patients fully recover and are able to eat any kind of food, others have theirs prepared to a specific texture such as puréed, nectar thick, or honey thick.
Each patient gets an individualized plan. For example, coffee lovers will understand the pleasure derived from their morning cup, but some patients might not be able to consume traditional coffee because of an inability to safely take in liquids. But it might be that a thickener can be added so the patient can get that daily cup.
Helping to make those improvements – big and small – makes the speech pathologist’s role rewarding.
“I find so much enjoyment out of that,” Cable said, “knowing that I’ve helped them. It’s a big deal.”
Martha Hale agrees, and she will tell you that every little bit of normalcy helps. For the longest time, she couldn’t eat anything but can now enjoy soft foods. Meatloaf is her favorite.
“She (Amanda, her speech pathologist) does a remarkable job,” she said. “It’s wonderful. You can chew your food. You can taste it.”
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