Newsletter :: September 2004

recommended for NPO and 67 of those continued PO with the implementation of compensatory strategies or facilitative techniques! That is what we love about our job!

A CONTEST!!!! We are beginning a new contest. At the end of each month, we will pick the top 5 facilities/SLP’s that are consistently efficient with getting all of their required paperwork in before the study and having their patients ready to roll out the door at the scheduled time we arrive. These SLP’s will receive a gift certificate for dinner. The rules are very simple: 1) have all required paperwork faxed in before the study, 2) have the patient up, with vitals, and ready to roll out the door when we arrive. This is just our way to say thank you for your hard work to help make our day run smoothly and timely! We appreciate you! Contest will begin September 1^st and we will contact the winners for the month, on October 1.

Interesting new research – Parkinson’s and red meat consumption – In October of last year, Brazilian researchers published a study; high does of riboflavin and the elimination of dietary red meat promote recovery of some motor function in Parkinson’s disease (PD) patients. The study authors observed that the digestion of red meats releases hemin, a toxin that is destroyed by a specific enzyme. This enzyme, however, requires adequate stores of riboflavin. Individuals who have deficiency of riboflavin, therefore, may not be able to properly eliminate hemin. The researchers speculate that hemin might reach the brain and contribute to the damage seen in PD. Therefore, they decided to eliminate red meat as well as provide riboflavin. In this small study of 19 patients who completed the six month treatment showed significant gains in standing, walking, balance, and other motor functions the first 3 months. For more information visit www.nutritionucanlivewith.com

Dysphagia Tidbit – Mealtimes can be a challenge on dementia units in long-term care facilities. The ability of someone with advancing dementia to maintain adequate nutrition and hydration by mouth can become quite compromised as the patient approaches end stage. Their eyes see food, but their brain may not know what to do with it. At this point the speech-language pathologist often is asked to get involved and do something to get the person to eat. The usual approaches well known among clinicians are reducing extraneous stimuli; alternating tastes, textures and temperatures; talking calmly and quietly to patients; and placing a cup or utensil in their hand. Other methods that complement these general strategies can be taught easily to and used by the nursing assistants who do the feeding. If a person you are feeding becomes agitated and resistant, stop! Back off for a minute, give them time to re-orient to the meal in front of them, and then continue feeding. Patients with dementia can be highly distractible, which isn’t always bad. Sometimes a moment or two away from the task and their agitation and a gradual coming back may be all they need. The Show and Tell method keeps patients involved in your presentation and approach as you feed them. As you get a bite ready, tell them what they need to do: “Okay, let’s take another bite” or “Try some vegetables; here you go.” Don’t ask them if they want the next bite; they’ll probably respond negatively. Hold it up in front of them so they can see and identify it, and don’t rush them. Give them a verbal cue as you approach them with it so they know the goal and can start forming a motor plan to manage the bolus, then verbally reinforce their acceptance. One thing I’ve learned in dementia unit dining rooms is that many of these folks don’t like surprises, so show them and tell them. The Hide and Seek method is based on the concern that patients who see a bite of food coming toward them may become more agitated and vehemently resist because of their decreased ability to correctly interpret what the clinician is doing. This approach involves sitting quietly next to patients with a bite of food ready where they can’t see it. When their mouth opens, as frequently happens with an agitated patient, plug ’em! Touch and Go is a helpful technique for patients who either don’t open their eyes or don’t open their mouths to accept the bite of food they see. Simply touching their lips with a utensil, cup or straw can work as a tactile cue for them to open up. If they have a prolonged oral phase or persistent chew, just presenting the next bite sometimes can facilitate the completion of the previous one. Finally, de-stimulation is a method that can be tried with patients who don’t initiate the eating task and respond poorly to verbal entreaties. Dining rooms in large nursing homes can be busy, noisy places. Patients are often over-stimulated before they’re even served their meal. The last thing they need is more stimulation. You should clear the table in front of them, hold the dish in your hand, and quietly feed them. Admittedly, this is nothing new in the approach to feeding patients with dementia, but it’s surprising how little it’s actually practiced unless we’re vigilant in our training of nursing assistants. Because meals may take a bit longer using these methods, start with the highest-calorie items first. If necessary, consult with the facility dietitian about increasing the caloric density of what the patient can get down successfully. As clinicians, we must train staff members to utilize the most effective methods of presentation, approach and delivery to facilitate maximum PO intake with these patients. Any strategy we use depends on the patient’s level of dementia and presenting behaviors. We also have to be able to adjust our method to the patient’s response, from meal to meal or during a meal. Working with patients who have dementia requires patience and the ability and willingness to connect with them to help maintain their quality of life by enjoying one of the last pleasures they may have — eating a good meal. Dan Sherwood Jewish Home and Care Ctr, WI