To: Alastair McIntosh who wrote (105427 ) 3/22/2005 4:49:07 PM From: MulhollandDrive Read Replies (1) | Respond to from the abstract....If Theresa were capable of orally taking nutrition and hydration, this GAL suggests that Theresa’s reasoned best wishes might be not to choose to stop eating, depending upon the difficulty, burden to others and costs involved. The conduct of swallowing tests by an independent, competent clinician, shielded from the public process, would provide competent, scientifically based medical evidence as to Theresa’s ability to swallow and whether swallowing therapy could improve her capability to orally eat and hydrate. Three general methods of swallowing test can be performed to assess swallowing capacity and swallowing potential. A bedside test examines cranial nerve function, speech potential and trials of certain food textures through spoons, syringes, straws and cups. It is relatively non-invasive and low risk, with the exception of silent aspiration – which is the unnoticed sucking of food or water into the lungs, rather than transporting it down the throat. The second is also bedside based test, call Flexible Endo Exam Swallowing (FEES). A nasal tube is inserted and spontaneous swallowing is observed, again using various textures of liquid and foods. This is a bit more objective and also has the advantage of being done at the bedside. The recognized gold standard test is the modified barium swallowing test, generally done in a hospital or at a facility that has radiology equipment. Theresa’s three previous tests were barium swallowing tests. Swallowing therapy, if swallowing potential is identified, may consist of posture management (head and neck positioning), training to focus on the food ingestion process, holding utensils and other activities. Electrical stimulation therapy has been promoted, but there is no objective, scientific evidence as to its effectiveness or value. The ability to orally ingest food and water – to swallow substances other than saliva, is predicated on a level of cognitive capacity. Without cognitive capacity, the intentional act of oral nutrition and hydration is likely to lead to aspiration. Eating and drinking are
