TASTINGS

I noticed a trend a few years ago, when working as the SLP for a subacute rehabilitation unit within a Midwestern general hospital. Older patients, both those on my caseload and those not, were turning up their noses at the salt-restricted diet prescribed during their rehabilitation stay. The patients often not on my caseload were cared for by orthopedic surgeons. They had undergone either hip or knee replacement; a fractured femur or tibia. It often wasn’t that the patients were struggling to swallow their food. It wasn’t that dementia had taken hold of their drive to eat and drink. There were also few signs, in the majority of cases, that these patients were in the throes of another acute disease (cancer), or a degenerative (PD, MS, ALS) or chronic (late effects of stroke or TBI) condition. In the majority of cases, the food simply did not taste good to the patient. I wondered how often this happened.

 It did not matter if the patient had entered rehabilitation with medical restrictions on her/his diet, or that it had been newly prescribed following surgery. The patient may or may not have demonstrated her understanding to the doctor, that salt included in the diet had become a mechanical load prohibiting good general health. When the food did not taste as good as they wanted, they ate less.  For those persons with diabetes who are also refusing to eat, there is then a crisis of medical management. You may say that such a situation is outside the SLP’s scope of practice, and our caseloads are bulging as it is. In many worksites, that may be true.

The SLP’s unique skill set for training behavior change, together with the knowledge base the field has achieved in dysphagia management, may give her/him an advantage to help meet a need for persons on salt-restricted diets. A clinician’s powers of observation may help her/him see signs of the noncompliance first: Fast food bags in the trash can; salt shakers pushed back to the corner of a drawer; or hushed negotiations by patients in the hallways for ‘black market salt’. And so, you’ve identified these persons who want little to do with salt restrictions.  There are a cadre of professional staff (nurses, nutritionists, doctors) educating them on the risks of neglecting sodium restrictions. Persons who are enabling the patient to get salt are concerned about the patient’s comfort during their hard rehab work. The SLP, with some assistance from the rehab team, may contribute some practical answers. 

An occupational therapist and I led this group activity in a subacute rehabilitation program, so a shout out goes to Mara Chiocca (nee Sonkin), OTR/L at Edward Hospital in Naperville, IL. Patients in this group, who had expressed an interest in gardening, not only harvested some fresh herbs but also used the herbs to prepare a spread, sampled on crackers as a “tasting”. It wasn’t always great cooking, but it became a lot of fun for all. Not only can it facilitate older adults’ adaptation to diet changes, but also stimulate cognitive processing and psychosocial interaction, and encourage return to leisure activities after discharge. Here is a re-creation of how we did it.

 

* The herbs were harvested immediately prior to preparation – in this case, from the Aero Garden planters that were positioned in corners of our multipurpose activity room.

* In this example, basil leaves are rolled into a “cigar” to allow easy chopping for the flavor in the spread. 

* A package of cream cheese is softening during the preparation of the herbs.

* The chiffonade of basil gives you easily managed long strands. 

 * Stir and mix thoroughly the chopped herbs into the soft cream cheese.

* Ready to serve – or to chill and serve later! Spread on a soft cracker or flatbread. 

The consultation includes the preparation and enjoyment of a tasty recipe, one you acquire or develop with your patients. Once your presentation, from garden harvest to food sampling, is perfected, then future presentations may be part of the patient’s routine education while in the hospital. All the steps preceding the actual tasting can be captured on video for convenient DVD playback, at the convenience of the patient, family and rehab team. The SLP in this fashion can be part of an effort in group treatment to help educate patients and prevent chronic disease. 

(originally submitted in different form to ASHAsphere, the blog of the American Speech-Language-Hearing Association)