These are handouts I created and provided to a patient at the Community Hospital of the Monterey Peninsula. The first handout reviews general information about dysphagia, signs and symptoms of aspiration, and standard aspiration precautions. The second handout was developed on-the-spot for a client-specific educational dysphagia session. I performed this patient's Modified Barium Swallow Study (MBSS), which revealed mild-moderate oropharyngeal dysphagia in which the patient was placed on a soft and bite-sized diet with nectar-thickened liquids. I have also included the patient's MBSS to provide greater insight into his swallow function. Although I did not review this written report with the patient, he was provided extensive education on the severity of his swallowing impairment. At the time of the MBSS, the patient was shown images from his study and educated on swallowing anatomy and function, as well as the overall results and recommendations. 

The patient was an 80-year-old male with a left frontoparietal subdural hematoma, presenting with apraxia and dysphagia. Apraxia of speech results in impaired motor planning and execution of movements, which can lead to swallow dysfunction. Precise motor sequencing is required for effective performance in exercises (Trupe et al., 2018). The patient was not appropriate for dysphagia impairment-targeted exercises at this stage of his recovery. We did not want to inappropriately train motor movements that could further impact his swallow function. The patient also fatigued quickly, resulting in poor secretion management and increasing his risk of aspiration during intensive exercises. He was placed on the Free Water Protocol as it has a relatively low risk of aspiration pneumonia and has the potential to support hydration and quality of life (Panther 2005). This educational session reviewing compensatory strategies and aspiration precautions was overall effective. Each item was reviewed, with the patient expressing verbal agreement and understanding. When given oral trials, the patient was able to implement these strategies with minimal verbal prompting. I recognize the importance of caregiver training and carry-over assessment in dysphagia management; however, this patient was discharged to IRU for intensive rehabilitation services! 

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Panther, K. (2005). The Frazier Free Water Protocol. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 4–9. https://doi.org/10.1044/sasd14.1.4

Trupe, L. A., Mulheren, R. W., Tippett, D., Hillis, A. E., & González-Fernández, M. (2018). Neural Mechanisms of Swallowing Dysfunction and Apraxia of Speech in Acute Stroke. Dysphagia, 33(5), 610–615. https://doi.org/10.1007/s00455-018-9879-6