Intervention Procedures and Outcome Measures of Neurogenic Dysphagic Clients seen by Speech and Language Therapists in Two Hospital Settings

Abstract

Dysphagia is a common problem in clients with neurological impairments. In Sri Lanka, managing dysphagic clients by speech therapists is a new and emerging field in the healthcare sector. However, no in-depth analyses concerning intervention procedures for neurogenic dysphagic clients have yet been conducted in the Sri Lankan context. Intervention procedures, outcome measures in use, and the discharge criteria of adult neurogenic dysphagic clients were studied retrospectively using 80 records of neurogenic dysphagic clients from two hospital settings. Semi-structured interviews were also conducted with the speech and language therapists working in the two selected hospital settings to identify their views on the intervention processes of managing dysphagic clients. Both compensatory and therapeutic modalities were used to manage 35 (43.75%) of clients whereas 29 (36.25%) of clients were managed using compensatory strategies only. Among the compensatory procedures, texture modification (n= 65, 81.25%) was identified as the most common strategy and swallow maneuvers were recommended less frequently (n=8, 10%). Outcomes were measured mainly through subjective measurements on level of aspiration, respiratory status, food intake, weight gain and hydration. The clients were discharged from therapy services when they were safe with oral feeds or when an alternative feeding method was recommended for a long duration. Intervention procedures were mainly based around a compensatory approach. Despite the limited resources in these settings, the speech therapists have been able to provide intervention for dysphagic clients and gain positive outcomes.