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Exploring Current Sensory Enhancement Practices Within Videofluoroscopic Swallow Study (VFSS) Clinics

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Abstract

Whilst some research evidence supports the potential benefits of sensory enhancement strategies (SES) in dysphagia management, there is limited understanding of how SES are used in clinical services and the influencing drivers involved in selection during instrumental assessment. SES include modification of temperature, flavour, texture, chemesthetic qualities and bolus size of food/fluid. This study aimed to explore the use of SES within Australian Videofluoroscopic Swallow Study (VFSS) clinics providing adult services, via a qualitative methodology. Maximum variation sampling was used to select a cross section of speech-language pathologists (SLPs) with a range of experience working within 16 VFSS clinics across metropolitan and regional settings to participate in semi-structured, focus group or individual teleconference interviews. Content analysis of interview transcripts was conducted, with four themes emerging as influencing drivers of SES use, including: Patient factors influence SES use; Clinician factors influence SES use; Trials of SES require planning and organisation, and; Organisational barriers impact on SES use. These four themes were all connected through a single integrative theme: Extensive variations of SES procedures exist across clinical settings. Findings indicate that achieving alignment of clinical purpose and implementation of practices amongst VFSS clinicians will be complex given current diversity in SES use. Organisational issues and clinician training need to be addressed, and more research is needed to provide a stronger evidence base to inform clinical practice in this emerging area of dysphagia management.

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Acknowledgments

The authors would like to thank the valuable contribution provided by study participants who generously offered their time to complete the teleconference interviews and content checking as well as the Speech Pathology service, Royal Brisbane and Women’s Hospital, The Royal Brisbane and Women’s Hospital Foundation Trust and the University of Queensland for the provision of significant support to complete this study.

Author information

Authors and Affiliations

  1. Speech Pathology Department, Royal Brisbane and Women’s Hospital, Queensland Health, Level 2, Dr James Mayne Building, Herston, QLD, 4029, Australia

    Leisa Turkington & Anna Farrell

  2. School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4027, Australia

    Rebecca L. Nund & Elizabeth C. Ward

  3. Centre for Functioning and Health Research, Queensland Health, Buranda, P.O. Box 6058, Brisbane, QLD, 4102, Australia

    Elizabeth C. Ward

Authors
  1. Leisa Turkington
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  2. Rebecca L. Nund
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  3. Elizabeth C. Ward
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  4. Anna Farrell
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Corresponding author

Correspondence to Leisa Turkington.

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The authors declare that they have no conflict of interest.

Appendix 1: Interview Guide–Core Questions

Appendix 1: Interview Guide–Core Questions

Tell me about compensatory techniques that you use in VFSS clinic

  • Potential Probes: Can you think of specific postural strategies/swallow maneuvers that you use?

    • When do you use these strategies?

    • How frequently do you use these strategies?

    • Can you give me an example?

  1. 1.

    Tell me about any sensory enhancement strategies (SES) that you use in your clinic?

    Potential Probes: Can you think of specific SES strategies (taste, temperature, carbonation)?

    When do you use these strategies?

    How frequently do you use these strategies?

    Can you give me an example?

  2. 2.

    Describe your SES preparation methods

    Potential Probes: Do you follow set procedures when preparing SES?

    Do you have recipes?

  3. 3.

    What order do you trial SES in your clinic?

    Potential Probe: Do you trial SES in a specific order? Why?

    Are SES trialled in your clinic with reference to other compensatory strategies?

  4. 4.

    Describe any positive outcomes you have encountered when using SES within VFSS?

    Potential Probes: Can you give me an example?

    What was the case?

    What happened?

    Who else was there?

    What did you do?

  5. 5.

    Now describe any challenges you have encountered when using SES within VFSS?

    Potential Probes: Can you give me an example?

    What was the case?

    What happened?

    Who else was there?

    What did you do?

  6. 6.

    Tell me about any contraindications you consider when using SES?

  7. 7.

    Tell me about the particular clinical populations you will/will not trial SES?

    Potential Probes: Why/why not?

  8. 8.

    Describe the recommendations you make following SES testing within VFSS clinic?

    Potential probes: Are results used to guide diet recommendations ?

    Are results used to guide direct swallow stimulation trials ?

  9. 9.

    Tell me how your clinical background and experience influences your use of SES in VFSS clinic? Do you have examples?

  10. 10.

    Rounding up: This project attempts to identify key drivers which influence selection of SES within VFSS. Before we close is there anything else we have not discussed that could help me to understand the factors that influence your selection of SES in VFSS?

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Turkington, L., Nund, R.L., Ward, E.C. et al. Exploring Current Sensory Enhancement Practices Within Videofluoroscopic Swallow Study (VFSS) Clinics. Dysphagia 32, 225–235 (2017). https://doi.org/10.1007/s00455-016-9747-1

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  • DOI: https://doi.org/10.1007/s00455-016-9747-1

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