For National Nutrition Month (March), we are all reminded to evaluate our diets and consider ways to improve our nutrition and habits, like cutting sodium or minding portion sizes.

However, some people require more complex solutions. For example, patients with swallowing and cognitive difficulties or comorbidities need special interventions to ensure adequate nutritional intake. RehabCare Speech Pathologist Michelle Tristani shares common challenges and strategies for meeting nutritional needs for patients with dysphagia, a swallowing disorder, and other conditions that may present feeding issues.

For patients with dysphagia, which can be caused by stroke and is seen more frequently in the elderly, alternate methods of food delivery must be considered to provide nutrition and prevent patients from accidental aspiration. "There are many nutritionally dense dietary supplements available to us," says Michelle. One of the most helpful tools is a supplement called Magic Cup." Magic Cups are nutritionally dense and have a pleasing taste. Magic Cups are an excellent choice for patients who require thicker textures to protect their airways.

To prepare supplements and meals, SLPs coordinate with dining staff and work together through role delineation to suggest effective feeding techniques for specific patients. "Daily communication with dining services prior to and after mealtime is paramount," says Tristani. "Therapists, nursing staff and nutrition services staff build a rapport and get on the same page regarding the patients' modified diets."

The good news is that options for swallowing interventions and compensatory strategies are also many and growing. "From oral motor, pharyngeal and laryngeal exercises to chin tuck postures, the main goal is to select the appropriate individualized set of strategies that will benefit our patients." Some patients benefit from technology that provides biofeedback and gives the therapist a deeper view into body functions and each patient's muscles when they swallow.

There is not a one-size-fits-all swallowing intervention. Clinicians educate patients and their families on the methods, risks and benefits so that they may make informed decisions. "We support our patients' right to choose," adds Michelle.

Patients with cognitive conditions may require therapists to take more control. Alzheimer's patients sometimes wander and ambulate during most of the day. Instead of requiring these patients to sit for a period of time and eat a meal, therapists will trial finger foods to be consumed along a patient's walking route.

"In every case, being flexible, working as a team and being attuned to the patient's needs contributes to positive outcomes for our patients with nutritional challenges," says Michelle. "We keep the patients' best interests at the forefront."

By Margaret Schmidt