Ewan is a super smiley, 9 year old who loves Lego, rugby, watching TV and films and spending time with his friends and family. Ewan has a diagnosis of Cerebral Palsy and uses a wheelchair with a communication aid attached, accessed via eye gaze. Ewan has regular eating and drinking reviews from a dysphagia trained speech and language therapist. These reviews are often completed jointly with Ewan’s independent occupational therapist. He has received input from ATtherapy since October 2016.
Ewan’s Dysphagia input
Ewan has dysphagia which means difficulties with swallowing safely. He has difficulties chewing the food, swallowing thin fluids and coordinating a safe swallow when he is distracted, tired or there are loud noises. ATtherapy completed assessment across home and school environments and following this, implemented guidance, recommended new equipment, carried out risk assessments, embedded oral placement therapy and delivered training with the multidisciplinary team.
Ewan’s Dysphagia Guidance
Ewan has separate dysphagia guidance for home and school environments. Within the school dining room there is a high level of environmental distractions which can increase risk. Therefore, Ewan has an easier texture of food in his school guidelines with lots of information about how to minimise audio and visual distractions. Ewan’s guidance outlines; his needs, goals, food texture, drink modification, positioning requirements (for both him and his mealtime support), equipment, assistance required, likes and dislikes, communication and warning signs that Ewan is encountering difficulties.
The guidance is written with IDDSI (The International Dysphagia Diet Standardisation Initiative) descriptors which are internationally used to describe the texture of modified foods and thickened liquids for people with dysphagia. Kitchen staff at Ewan’s primary school have received training and have handouts and checklists to ensure the food is at the correct consistency.
ATtherapy changed Ewan’s thickener to a clear, gum-based thickener which improved the appearance of his drinks and was a more pleasant texture for Ewan. Consequently, Ewan is drinking more and his hydration needs are met throughout the day.
Ewan has developed his oral motor skills using an approach called Talk Tools, improving the strength of muscles in his mouth and their range of movement. Ewan’s mealtime length used to be 45 minutes to an hour. This has shortened significantly and he can now consume his main meal, dessert and drink within 30 minutes. This means Ewan is less fatigued which reduces risk.
ATtherapy created a mealtime communication grid set that Ewan uses every mealtime to direct his mealtime support when he is ready for a drink, something to eat, more or wants to stop. This helps to ensure Ewan is ready for the next mouthful which reduces the risk of food or drink going down the wrong way (aspiration).
Joint liaison with Ewan’s occupational therapist has improved Ewan’s positioning in his chair so his head, neck and trunk are all in good alignment to facilitate safe eating and drinking.
Ewan has safe, enjoyable mealtimes across a range of environments. Ewan’s parents and staff have the skills to support Ewan to eat and drinking safely. Ewan has a very good appetite and will regularly say “I’m hungry!”.