Thomas Case Study Essay

Question 5: In the case history it states that Thomas does not cough when he drinks and from the clinical swallow exam and the cranial nerve examination it has identified that Thomas demonstrates a pro-longed oral phase. There was no evidence that Thomas has any pharyngeal difficulties once he initiates the swallow. Therefore, it is appropriate to start oral food trials with Thomas as there is no potential risk of aspiration at this stage. Cichero and Murdoch (2006) have identified conditions that the client must be presenting when going to trial foods and liquids. These include the client being conscious and alert, can be but in the optimal position, have some ability to protect the airway, and not fatigued (Cichero, & Murdoch, 2006). The assessment should be completed how Thomas would normally eat, and sitting upright at a 90 degree angle (Daniels, & Huckabee, 2008).
Cited in Daniels and Huckabee (2008), research

An approach for Thomas would be to start with regular thin fluids that he would taking at home such as water. In the case history it mentions that Thomas does not cough while drinking water which is a sign he is not aspirating while doing this at home. Thin fluids need to have considerable oral and pharyngeal control and coordination (Cichero, & Murdoch, 2006). A hypothesis can be made that Thomas is able to drink the thin fluid (water) without difficulty as the clinical swallow examination has indicated that there is a prolonged oral stage, with adequate movement of the tongue, and without any pharyngeal difficulties that would cause Thomas to aspirate the water. Trialling Thomas with fluids before food would ensure that there is no residue from foods (Cichero, & Murdoch, 2006). Because Thomas can swallow water adequately at this stage, no other liquids such as thickened fluids would need to be