[tri-med] Re: Reflux meds?

----- Original Message -----
From: <StamTORCH@xxxxxxx>
> << I wouldnt allow anyone who had done them before to do it
>  and I absolutely refused to allow anyone to try and do a swallow study
with
>  him laying down >>
>
> Would you explain why please?  When they did a barium swallow on Michael
he
> was lying down.

Oops first up that should read "who hadn't done one before" - I wouldnt
allow and inexperienced technician to do a swallow study for eating.

Its the same as I wouldnt let an inexperienced therapist assess for eating.
For example I am an OT - but there is no way that I would consider myself a
feeding therapist. I know the basics (eg to assess a patient post stroke for
gag reflex etc) but I sure dont know enough re feeding issues in my own
humble opinion.

Inexperienced technicians often try and do a barium swallow laying down
because its easier and faster to get the pictures that way. But laying down
is a totally unnatural position to be eating in. Who do you know that lays
down to eat? Even if you are in bed you sit up slightly to take a sip of
water. Even babies on the breast arent flat. (and if they are they shouldn't
be)

You simply dont get an accurate picture of how efficient a swallow is when
the child is laying down. Plus in children with an inefficient swallow or a
borderline safe swallow so much can be done simply by positioning.

I have sat in on many feeding assessments and modified swallows, not for the
mechanics of the swallow (over here speech therapists do that more than
OT's) but to adjust the seating for feeding so that the child (or adult) is
in the safest position for eating.

For example I might adjust the seating by adding a cushion to the cervical /
thoracic region to encourage a chin tuck position when eating. Maybe adding
something firmer and higher under the feet. Maybe a childs swallow is unsafe
when a tilt in space chair is reclined, but OK when upright. All of these
can make an enormous difference to a swallow and you just can't see these
laying down. A good swallow may deteriorate laying down. And an unsafe
swallow may seem OK.

It depends on the clinic/hospital here. But the therapists I have worked
with tried to use the childs own chair for feeding if possible. If not they
usually used a tumbleform or a Frazer chair. (I donated my therapy frazer
chair for older kids to the therapist who did Alex's swallow study)

Laying down you cant see the effect of gravity, if there is pooling and what
happens with it if there is, if there is a problem like achalasia (lack of
peristaltic movement in the esophagus), tongue movement and so on.

If they simply did a barium swallow to check for a hiatius hernia, gastric
emptying etc laying down is OK - but not as part of a swallow study.

If Michael had a modified barium swallowing to assess the efficiency and
safety of his swallow laying down - I would personally consider asking for
another by someone who specialises in eating assessments.

 Hope is itself a species of happiness, and, perhaps, the chief happiness
which this world affords.
-- Samuel Johnson

Keep Looking for Rainbows!!!
Karen, Mum to Alex (7, T-18 mosaic)
Sydney, Australia
http://members.optushome.com.au/karens
http://www.trisomyonline.org


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