Your servant

{Chart reads: 62 y/o woman s/p LMCA stroke five days; severe expressive aphasia with lethargic sensorium; clinical swallow eval revealed moderately flaccid oral-facial muscle complex on the right side, affecting lip seal, bolus formation and propulsion, residue clearance; also, impaired strength and timing of swallow trigger, impaired airway protection, seen as gurgly phonation after swallow, yielding high aspiration risk: VFSS study brings recommendation of nothing by mouth for nutrition/hydration}

"Hello, Mary. I'm Carey, from speech therapy. We met the other day - ?  I am here to help you swallow better. The stroke affected your swallowing, so that now the doctor does not want you to eat normal food and drink for awhile. What we will do today may help you resume eating and drinking. Can we do that now?"

[Use statements, not questions, OK? That last one lets you show respect to her, but your non verbals of standing tall and nodding/smiling, while moving very slightly toward her may encourage her buy-in].

"First, Mary; let's warm up the mouth. You have to use the mouth in many ways when you chew and swallow. Let's start by stretching out the mouth muscles, so - please do what I do".

[Pointing to your mouth, then Mary's - stick out your tongue as FAR as you can; do it ten times then rest; move laterally in either direction, then rest; - she follows you better when you give her nonverbal cues, SO - teach her with your eyes, and of course you mouth, but also your WHOLE BODY - !  Yes, even your whole body!! When she doesn't have a lot of energy or focus, exaggerating the movements, going over the top can keep her engaged and relaxed, - even getting her to laugh near the end of the trials can help maintain the rapport you worked hard to attain].

"I'm clapping because I am happy for you, Mary! These stretches you are doing with your mouth may help you swallow more strongly, more quickly and more safely! And LOOK!  Your lunch here. I will be your coach during your meal and try to turn your improving skill into easier eating."

[I may dress and carry myself as an important, smart, skilled person to her. That may be true, but the bottom line reads that - I am her servant. I can take pride in what I help her do, and feel secure about the living I am making for my family; - but what need be remembered by this patient and her family is that, she got better. I promote myself and my profession much more, when I am to her a selfless servant.]