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Dysphagia management for adults with learning disabilities: Caregiver knowledge and barriers to their adherence.

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Abstract
This study investigates the factors that are associated with non-compliance
with dysphagia management strategies. Semi structured open ended
interviews were conducted with caregivers supporting adults with learning
disabilities and dysphagia to explore their knowledge of dysphagia
management, the potential risks of non compliance and the barriers they
experienced. Recommendations pertaining to altering consistency and using specialised equipment and utensils were recalled significantly more readily than those concerning support and prompting for the dysphagic persons. Moreover, caregivers adhered to management strategies to a significantly greater degree than they could recall the details of the written guidelines containing the dysphagia management strategies. Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving safe and appropriate positioning during mealtimes, and in implementing support, prompting and socialising related management strategies. Problematic mealtime support strategies included: difficulties with pacing appropriately; facilitating people to adequately relax and concentrate; and monitoring, observing and prompting people to pace appropriately and take appropriate amounts of food and drinks during mealtimes. Additional barriers identified included time pressures, staff turnover, and insufficient reviewing of SLT management strategies by caregivers. The practice implications for SLTs working with adults with intellectual disabilities and dysphagia and their caregivers are presented.

Authors
Darren D. Chadwick
Jane Jolliffe
Juliet Goldbart

Reference
Chadwick, D. D., Jolliffe, J., & Goldbart, J. (2003). Dysphagia management for adults with learning disabilities: Caregiver knowledge and barriers to their adherence. Proceedings of the 5th European CPLOL Congress, Evidence Based Practice: A challenge for Speech and Language Therapists, Heriott Watt Conference Centre, Edinburgh, UK, 5th – 7th Sept 2003.