For this MM, we introduce our new blog series: “Normalizing the Swallow” in which we discuss the wide variety of what NORMAL swallowing can look like. We also discuss ways in which SLPs can determine what might be normal for that patient vs an impaired swallow that would warrant a plan of care.
Our first clip in this series focuses on mastication. This patient from our Detroit market had been on a mechanical soft diet for quite some time. Was doing some coughing at meals, also at baseline (patient is COVID recovered). No choking episodes, lungs had been CTA for the last couple weeks, as well as on the day of the MBS. When our SLP arrived at the solid in our protocol, the patient demonstrated very little, if any, mastication of the bolus. It was pretty much just propelled posteriorly and swallowed. When making decision on the plan of care, our SLP took several things into account: the report that the patient had been eating this consistency for quite some time, the lack of history of choking, the fact that the patient’s airway protection and bolus clear was excellent, and finally the patient’s assertion that they “would NOT be eating that puree food all the time” … and recommended continuing with mechanical soft.
If we only looked at the data gathered on the MBS, it might be tempting to just dash off a recommendation of puree. But what does that say about us as a skilled service? Are we just diet recommenders? Or is our role to use our clinical knowledge to put all available information together to form the best plan of care for each patient?
Also… what do we know about what normal mastication looks like? Ever watch a 16 year old boy inhale his food? (I have one at home you can observe on the daily if you like!) It’s annoying, kinda gross, rude… and a little fascinating (if I’m being honest), but it’s NOT disordered and he doesn’t need to be on puree.
We have some evidence that mastication with full denture wearers is similar to the mastication of patients who are eating while edentulous, and that there is a wide variety of normal with regard the amount and time of chewing movements. So if we didn’t know what this patient’s mastication looked like “before”… how do we really know that they are now “disordered”? All very good reasons to use the full measure of our clinical expertise. Finally, take a look at our prior MM to watch our CLE SLP, Angela eat a can of chicken in about four bites. Pay close attention to the final swallow-it looks pretty similar to this patient, so if we aren’t using other information to make recommendations… why would Angela get to enjoy her chicken while this patient is put on a puree diet?