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Feeding & Swallowing During the Holidays: Telepractice Tips

Published December 2023 in the ISHA Voice

By Jennine Harvey & Valerie Brosius

Jennine is the chair of the Telepractice Committee, and Valerie is a member of the Telepractice Committee.  

As many prepare for the abundant festivities of the holiday season, it is important to consider the implications for patients with feeding and swallowing disorders. Recognizing that eating and mealtime experiences are more than a function of daily life, speech-language pathologists can proactively address intake, taking into consideration that mealtime experiences are a social event, intrinsic to an individual’s identity, the center of gatherings, and a manifestation of cultural, holiday, and/or religious traditions (Padilla et.al., 2019: Shune & Linville, 2019). Speech-language pathologists can enhance patient quality of life and engagement in their familial and cultural traditions by tailoring interventions to seasonal food experiences important to the patient and their family or caregivers.

Telepractice & Dysphagia Assessment and Intervention

Dysphagia services provided via telepractice have been found to be a safe mode of service delivery (Malandraki et al., 2021; Morrell et al, 2017; Raatz et al., 2021; Ward et al, 2022). Dysphagia assessment and intervention through telepractice service have been found to allow greater flexibility and access to care for patients limited by geography, travel accessibility, need for specialized services and/or multi-disciplinary teams, lengthy appointments, and medically complex patients (Ward et al., 2022). In addition, teletherapy offers the benefit of viewing the patient in their natural surroundings, observing their typical seating and posture, their mealtime experience and socialization, pace of intake, their role in food choices, their food preferences, and traditions (Riquelme, 2019) as well as the caregiver’s ability to comply with recommendations or execute clinical recommendations to facilitate safe oral intake (Malandarki, 2020). Further, Raatz et al. (2021) found that telepractice services yielded a unique opportunity for clinicians to observe pediatric clients eating in their home environments, while Malandarki (2020) emphasized the ability of the speech language pathologist to observe and “coach” the family or caregiver in their delivery of hands-on intervention, assisting the patient with feeding, repeating directions, and intervening when safety is at risk. This allows for a functional assessment unavailable in a typical clinical setting (Ward et al., 2022) and increased generalization into daily routines. Teletherapy also offers the opportunity for increased “coaching” and joint problem solving and planning (Caplan-Colon, 2021). However, the role of communication becomes increasingly important as the family or caregiver is responsible for explicitly implementing intervention, rather than just observing its delivery. Thus, a communication plan (email, video conferencing, phone/text messaging), parent/caregiver training sessions (Clarke et al., 2019) and recording of treatment sessions and therapist modeling of intervention/execution of the care plan are also essential.

Dysphagia & Culture

Food is often considered an important part of one's individuality, identity, and culture. Cultural traditions frequently revolve around food (Kenny, 2015; Threats, 2007). Specifically, cultural significance of these traditions can influence patient’s understanding of the dysphagia diagnosis, impacts to participation in preferred traditional and familial activities, and compliance of dietary restrictions (Kenny, 2015).

Best practices in offering patient-centered culturally competent care include valuing each patient’s individual preferences, which are impacted by culture, shared decision-making, the care team perspectives, and completing an ethnographic interview (Hall & Johnson, 2020). The speech language pathologist must also embrace cultural humility, acknowledging their own beliefs, privilege, biases, and values, and recognize how these may impact treatment. Thus, cultural humility is necessary to encourage trustworthy relationships with our patients and their families (Fahlberg, et al, 2016; Tervalon & Murray-Garcia, 1998). This leads to respecting the cultural parameters the patient is functioning within and understanding how culture impacts the individual’s coping with dysphagia (Padilla et al., 2019). Fahlberg et al, (2016) urges us to seek understanding, proactively ask for information about traditions, role of touch, age, power differences and respect when taking/giving direction, and learning what the patient wants, needs, values, and expects this holiday season as the plan of care is established.

Dysphagia Tips for the Holiday Season

The implications of dysphagia during the holiday season cannot be underestimated. In a season where many are celebrating with cultural festivities and traditions that center around food, patients with dysphagia are at a distinct disadvantage. As speech-language pathologists, we must look at the preferred diet and think about consistency, food preferences, and the role of texture, temperature taste, and volume of each bolus (Riquelme, 2007) as prepare patients and their caregivers to modify their foods and strategies to be successful during these events. How the patient and family or caregiver perceive the recommendations impact their follow through and degree of compliance (Riquelme, 2007).

General Tips

  • Take small, slow bites
  • Take sips between bites or swallow twice if needed
  • Many holiday foods are pureed
  • Reduce distractions
  • Increased lighting
  • (Sheffler, 2021)

Cultural Consideration Tips

  • Listen and be collaborative
  • Be open to differences in perspectives and view of what is important
  • Respect difference, recognizing that food is a personal choice and may be culture/tradition bound
  • Discuss the role of touch, giving and receiving direction as they relate to safety
  • Consider how the recommendations will impact the patient’s participation in traditions and the likelihood of compliance
  • Discuss the distinct roles of family and dynamic of power/respect
  • (Riquelme, 2007)

Pediatric Tips

  • Prepare kids by discussing the events, traditions, and foods.
  • Include kids in the food preparation and cooking.
  • Present food in a fun theme.
  • Prepare other mealtime attendees with how to support the client(
  • ASHA, 2022)

References:

ASHA.  (2022). How to Help Children with Feeding Difficulties during Holiday Meals. American Speech-Language-Hearing Association.  https://www.asha.org/news/2022/how-to-help-children-with-feeding-difficulties-during-holiday-meals/

Caplan-Colon, L. (2021). Coaching parents on feeding techniques via telepractice. ASHA Leader, 26(1), 42–43.

Clark, R.R., Fischer, A.J., Lehman, e. L., & Bloomfield, B.S. (2019). Developing and implementing a telehealth enhanced interdisciplinary pediatric feeding disorders clinic: A proram description and evaluation. Journal of Developmental and Physical Disabilities, 31(2), 171-188. https://doi.org/10.1007/s10882-018-9652-7

Fahlberg, B., Foronda, C. & Baptisite, D. (2016). Cultural humility: The key to patient/family partnerships for making difficult decisions. Nursing 46(9), 14-16.

Hall, K. D., & Johnson, L. W. (2020). The Three CCCs of Dysphagia Management: Culturally Competent Care. Perspectives of the ASHA Special Interest Groups, 5(4), 1000–1005. https://doi.org/10.1044/2020_PERSP-19-00112

Kenny, B. (2015). Food Culture, Preferences and Ethics in Dysphagia Management. Bioethics, 29(9), 646–652. https://doi.org/10.1111/bioe.12189

Malandarki, G. A. (2020). Telehealth recommendations for dysphagia management during COVID-19. Purdue IEat Research Lab. https://www.purdue.edu/i-eatlab/part-c-how-to-do- this-technology-and-practical-guidelines/.      

Malandraki, G. A., Arkenberg, R. H., Mitchell, S. S., & Malandraki, J. B. (2021). Telehealth for Dysphagia Across the Life Span: Using Contemporary Evidence and Expertise to Guide Clinical Practice During and After COVID-19. American journal of speech-language pathology, 30(2), 532–550. https://doi.org/10.1044/2020_AJSLP-20-00252

Morrell K, Hyers M, Stuchiner T, et al. Telehealth stroke dysphagia evaluation is safe and effective. Cerebrovasc Dis. 2017;44:225–231. doi: 10.1159/000478107.

Padilla, A., Palmer, P. & Rodriquez, B. (2019). The Relationship Between Culture, Quality of Life, and Stigma in New Mexicans with Dysphagia: A Preliminary Investigation Using Quantitative and Qualitative Analysis. American Journal of Speech Language Pathology 28(2), 485-500. https://pubs.asha.org/doi/epdf/10.1044/2018_AJSLP-18-0061

Raatz M, Ward EC, Marshall J, Burns CL. Evaluating the Use of Telepractice to Deliver Pediatric Feeding Assessments. Am J Speech Lang Pathol. 2021;30(4):1686-1699. doi:10.1044/2021_AJSLP-20-00323

Riquelme, L.F. (2007). The Role of Cultural Competence in Providing Services to Persons with Dysphagia. Topics in Geriatric Rehabilitation 23(3), 228-239. https://www.researchgate.net/publication/228Riquelme2019068513 

Sheffler, K. (2021).  Tips for Managing Dysphagia at Home During the Holidays.  Health Resources, Hormel Health Labs. https://www.hormelhealthlabs.com/resources/tips-for-managing-dysphagia-at-home-during-the-holidays/

Shune SE, Linville D. Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis. International Journal Nursing Stud. 2019 Apr; 92:144-153. doi: 10.1016/j.ijnurstu.2019.01.017. Epub 2019 Feb 8. PMID: 30822707.

Tervalon, M. &Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved 9(2), 117-129. https://melanietervalon.com/wp-content/uploads/2013/08/CulturalHumility_Tervalon-and-Murray-Garcia-Article.pdf

T.T. Threats. Use of the ICF in Dysphagia Management. Seminars Speech Lang 2007; 28: 323–333.

Ward, E. C., Raatz, M., Marshall, J., Wishart, L. R., & Burns, C. L. (2022). Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia, 37(6), 1386–1399. https://doi.org/10.1007/s00455-022-10444-2

Jennine Harvey is an Associate Professor at Illinois State University in the Department of Communication Sciences & Disorders. She has 15 years of clinical experience working with adult neurogenic communication disorders. Dr. Harvey conducts research in the areas of cognitive aging, cognitive and language interventions, dual-task, speech in noise, virtual reality for rehabilitation, interprofessional practice, and scholarship of teaching and learning.

Valerie Brosius is the current President of the Council of State Association Presidents (CSAP), the Chair of the Site Visit Education Training Committee, and a member of the CAA. She is a bilingual SLP and delivers instruction at NIU addressing the intersection of bilingualism and disability, including bilingual assessment and intervention. Valerie is a Jerry Johns recognized speaker and presents at the national level.