Partners of the speech therapist in management of swallowing disorders; establishment of an interdisciplinary project

Abstract

During the first three months after a stroke, healthcare teams are confronted to feeding problems such as swallowing disorders. Many studies have revealed that 91% of patients suffer from lating swallowing reflex (AHCPR, 1999; Veis and Logemann, 1985). Assessment and management are available in the acute care but are unknown later and in consequence not applied during the rehabilitation. However, the continuity of care is a major issue because swallowing disorders may have negative even vital effects. Rehabilitation team called “Filiere AVC Lille Flandre Lys”, which includes four speech therapists, works with eight rehabilitation hospitals as partners. Since January 2013, an improvement project has been implemented with all partners regarding to post-stroke dysphagia. The aim of this project is firstly to improve and secure the management and support of swallowing disorders, and secondly to integrate it in everyday practice from acute to rehabilitation care. This project helps speech therapist to identify team's knowledge about dysphagia but it also offers theoretical and practical training programs to any nursing staff and participant. A referent is nominated and become the main spokesperson for the team and also for the speech therapist. In consequence, the management of dysphagia is optimized (texture, prevention of complications, internal communication). Another aim is to promote exchanges between referents to compare practices and communication tools in their care units, and to develop adapted menus for dysphagic patients, in an interdisciplinary approach. The management of this project by a speech therapist shows the necessary evolution of this profession at hospital. Beyond its abilities in assessment and rehabilitation, the speech therapist's role is to create link between all the people involved in daily life having an action on the feeding conditions of the patients. The action of the speech therapist is no longer restricted one to one patient/therapist relation. It is important for the speech therapists to become aware of it and for hospitals to integrate this new dimension of the practice.