presented by Michael Groher
Selecting the best route to provide nutrition in adults with dysphagia can be controversial and difficult. The speech-language pathologist (SLP) often assists in this decision, making recommendations either for oral or feeding tube placement. Some patients or the patient’s family reject the use of feeding tubes even though the medical care team feels the patient’s health may be at risk with continued oral feeding. Such situations create potential medical, legal, and ethical dilemmas that need to be addressed by the medical care team in conjunction with the patient and family. This course will explore the ramifications of these interactions with suggestions on approaches the SLP may take in their role as the dysphagia specialist in a medical setting.
Michael Groher is an Emeritus Professor of the Department of Communicative Disorders at the University of Redlands in Redlands, California. Dr. Groher has spent most of his career working as a medical speech pathologist in acute and long-term care settings. The majority of his hospital work was done for the Department of Veterans Affairs in Seattle/Tacoma, New York, and Tampa. He is best known for his pioneering work with patients who have swallowing disorders. The majority of his work is summarized in three texts: Dysphagia: Diagnosis and Management (three editions), Introduction to Adult Swallowing Disorders, and Clinical Management of Dysphagia in Adults and Children, second edition. Dr. Groher is an ASHA Fellow and Honors recipient as well as a past founding associate editor for the journal Dysphagia. He is an honorary member of the Japanese Society of Dysphagia Rehabilitation.
This chapter will cover some of the basic underlying concepts that guide the relationship between physicians and patients. In turn, they guide the role of the SLP when making oral feeding decisions.
This chapter will present the various methods of tube feeding and the risks and benefits. Knowledge of potential alternate routes may influence the SLP’s decision when making recommendations for oral feeding.
There are some common dilemmas that arise when the SLP feels a patient is not a candidate for oral feeding, but others disagree. Case examples with potential solutions can assist the SLP solidify their decision-making processes in an effort to solve the dilemma.
The SLP may be the sole professional who determines that a patient is safe to return to oral feeding after having been tube-fed. Knowledge of approaches to ensure safety and success in this circumstance is important.