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Rehabilitation

Several hundreds of audiologists, occupational therapists, physiotherapists, nutrition specialists, art therapists and other rehabilitation professionals came together for the First Latvian National Congress of Rehabilitation Medicine which took place on 19 – 20 September at Rīga Stradiņš University (RSU). Dysphagia, or swallowing difficulties, was one of the themes discussed during the congress. The Head of the RSU Rehabilitation Research Laboratory and a doctor of physical and rehabilitation medicine, Professor Aivars Vētra, and RSU researcher and audiologist and speech therapist Santa Salaka explain what dysphagia is, and give advice on how to manage it.

‘Dysphagia is a relatively common disorder that can develop as a result of a head injury or various diseases, such as stroke, or as people age,’ explains Prof. Vētra. One of the most serious complications is the risk of choking that can cause lung inflammation or suffocation. Patients can also be at higher risk of malnutrition or insufficient nutritional intake.

According to Salaka, people with dysphagia should turn to a specialist for help in order to create the right approach for them, but while they are waiting to see a specialist, they can follow these guidelines:

1.    Position

The person with dysphagia should always be seated - ideally at a 90-degree angle with their back against the chair. The pelvis and chest should be stable with both feet on the ground. The head is looking forward, the chin should be turned slightly downward and pressed back, in this way controlling the airways and how food passes through the mouth.

If the person is sitting up in bed, pillows can be used to support the back, once again retaining a 90-degree angle with a stable pelvis and torso. The head should be straight, and the chin slightly pulled down and back. The same pose can be used if the patient is sitting on the side of the bed. Pillows can be used to stabilise them from all sides.

2.    Oral hygiene

It is best to clean the oral cavity both before eating, in this way cleaning out coating and improving sensation and control, as well as after eating. This can be done in one of the seated positions described above. If this proves difficult, the person can also lie down on their side.

You can clean the oral cavity with a baby toothbrush, or a toothbrush with especially soft bristles. You can also use a wet tissue or wrap your finger with gauze. If you choose to use toothpaste, it is best to use toothpaste without fluoride and preferably without lather. The toothpaste can be removed by using a wet or a normal tissue.

3.    Diet and eating habits

The room where the person eats should be as calm and quiet as possible, without external stimuli that could deflect attention, such as a TV. The temperature of the food should be regulated. The patient should not try to eat and drink at the same time.

The patient should eat often throughout the day, but keep portions small. It is preferable to eat at regular times. It is important to make sure that the oral cavity is empty before taking the next bite which should be small.

It is important to avoid dry foods – absolutely no biscuits, crackers, nuts or tough meat. ‘If it’s possible to choose foods - choose fruit sauces, jelly, custard, yoghurt, creamy soups or mashed potatoes. Stay seated for at least 30 minutes after eating, and only then get up to continue your day,’ explains Salaka.