Swallow and Follow

By: Rachel Amsellem

Swallowing, of course, is essential for patients to get the energy, fluids, and nutrients they need. During my rotation at Meritus Medical Center, I learned how speech language pathologists (SLPs) and dietitians work together to assess and manage swallowing problems in patients.  I was extremely interested in seeing a modified barium swallow (MBS) during my clinical rotation at Meritus Medical Center. Over the summer, I had to get a CT scan with contrast. I had no idea what to expect. I was told to drink a barium solution the night before and morning of the CT scan. I now understand that the barium was used as a type of x-ray dye. In a barium swallow procedure, the healthcare team can see the movement of the digestive tract. Radiologists and speech language pathologists (SLPs) are able to visually pinpoint where a patient is having trouble swallowing. They take a series of videos and images using X-rays of the mouth and throat as a patient swallows food and liquid of different consistencies.

I followed the SLP, Angela, to the first floor of the hospital where the patient was already in the X-ray room awaiting the study. We put on lead aprons and prepared different consistencies of drinks and food for the study. In dixie cups, Angela prepared honey-thick, nectar thick, and thin liquid drinks using the barium to mimic liquids with those consistencies.  In addition, she mixed a cookie with a barium pudding to represent soft and bite sized foods and graham cracker with a barium pudding to represent regular foods.

The MBS took around 10 minutes. Angela went one by one and announced which consistency she was giving the patient as I watched the X-ray on the screen and monitored the patient swallowing in real time. After the study, Angela labeled each video segment based on the consistency and if she saw any fluid enter the trachea. Angela was pleased because the evidence in the MBS matched the bedside swallow study she performed previously.

In addition, I was able to see some therapies that SLPs use to help patients with dysphagia, the official term for a swallowing impairment or disorder. Angela encouraged the patient’s swallow capability by implementing a chin tuck method. Reminding the patient about this therapy allowed maximal airway protection.

During this rotation, I also learned about the important role dietitians play for patients with dysphagia. Dietitians plan their menus, ensuring appropriate food textures and fluid consistencies are available while they are in institutional settings. They also counsel clients with dysphasia. In addition to the right consistency, many with dysphagia need guidance on good food choices that will help them get the nutrients and hydration they need. Meritus classifies liquid consistencies into four categories: thin, nectar, honey, and pudding. More facilities are moving towards the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI is a framework which describes different food textures and drink thicknesses.  Check out this handout I made below which includes different fluid consistencies and its equivalent in the IDDSI.

In looking at my experiences related to swallowing issues, I think it is beneficial for SLPs and dietitians to know what swallowing techniques and other recommendations they each are providing a patient.  By doing so, they reinforce good swallowing habits and make it easier and safer for patients to swallow. Overall, dietitians and speech language pathologists can provide coordinated, client-centered care when working together.

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