Party food enjoyed by all

As we approach Christmas, parties and party food are an important part of the festivities. We are busy planning for the Christmas parties in all of our homes, but for service users with acquired brain injuries and associated swallowing difficulties, this requires extra thought and care.

Party food accessible to all has been a regular theme for service users’ get-togethers, and the impact of eating and drinking difficulties on service users is a subject covered in staff training sessions. One of the things frequently discussed has been how to make party food – traditionally sausage rolls and sandwiches – accessible and appetising for those people who take a single textured diet.

A great deal of thought and planning is going into this year’s Christmas parties and we are looking forward to preparing a range of appetising food that can be enjoyed by everyone. The menu will include:

  • Tasty sandwiches made into a single texture using a soaking solution as advocated by the thickening manufacturers
  • Open sandwiches topped with tuna and cheese spread
  • Finger foods made from ingredients such as smoked salmon and mashed potato
  • ‘Bite and dissolve’ crisps
  • Tiramisu – a particular favourite and flavoured with drinking chocolate to achieve the perfect single texture

In the past we have also used shot glasses to provide small tasters of a range of different flavours to make a change for special occasions. We are all looking forward to having tasty party food that can be enjoyed by staff and service users alike.

Christmas tree and presents

Speech and Language Therapy Case Study

Speech and Language Therapy is one of the types of therapy provided by our Multi-Disciplinary Team for people who have acquired brain injuries. As well as helping with communication difficulties, our Speech and Language Therapist treats Dysphagia, or swallowing difficulties, to improve the individual’s well-being and quality of life, as well as reducing the risk of choking.

Mr P
Mr P had a traumatic brain injury following a motorbike accident. He sustained multiple contusions affecting bilateral frontal lobes and the right temporal lobe. He also had acute subdural haematoma and traumatic subarachnoid haemorrhage. He had previously been in a hospital neurological rehabilitation unit and came to The Richardson Partnership for Care 15 months after sustaining his brain injury.

Mr P had multiple impairments as a result of his brain injury, including cognitive difficulties such as problems with memory, attention and orientation, as well as cognitive communication difficulties and swallowing problems.

Dysphagia
Mr P had Dysphagia, or swallowing difficulties, due to nerve damage affecting tongue function. This meant that he had reduced ability to chew; when he swallowed the muscle movement in the tongue and pharynx was poor and sometimes poorly coordinated. There was also a delay in closing his airway and allowing the food to pass into the oesophagus. This meant that he frequently coughed and choked when eating and drinking.

He was taking thickened fluids from a specially adapted cup and puree diet that required no chewing. He did not enjoy the food.

Therapy programme
Mr P’s cognitive and language difficulties meant that we were limited in the therapy we could use. It had to be functional and highly motivating.

Mr P worked with a Speech and Language Therapist who devised a specific programme for him. This was combined with daily practice, supported by dedicated care staff.

We worked on his chewing skills using a variety of food types. This increased the intensity at which the muscles were working during the swallow. This programme was a form of progressive muscle training which enabled Mr P to improve the function of his eating and swallowing.

Alongside this we changed the specially adapted cup for a bottle with a sports top lid. This was more ‘normal’ and didn’t draw attention to his difficulties. It also limited the amount of fluid he could get at any one time (as opposed to an open cup).  We changed the thickened fluids to normal fluids, which he could manage because his muscle strength and swallowing coordination had improved through the therapy offered, and also because the smaller volumes were administered with a better head position.

Positive outcome
Mr P progressed well, and within a period of three months he was able to eat a normal diet, enjoying trips out to restaurants with his family.

Please note that we do not reveal the names of our service users in order to protect their privacy.

Helping people with dysphagia to enjoy food safely

Dysphagia (or difficulty with chewing and swallowing) is common amongst people who have had a stroke or other type of acquired brain injury. It is often caused by damage to the nerves and muscles of the head, face and neck and also by damage to the brain. If it is not managed properly, dysphagia can have a significant detrimental impact on the health of the person, leading to malnutrition or dehydration, because of inadequate intake of food and fluids. It can also increase the risk of choking or lung infections caused by food getting into the lungs.

One of the strategies that may be employed to help overcome certain difficulties of dysphagia is thickening liquids so they are easier to control in the mouth, and blending foods to form a paste so that they don’t require chewing.

Understanding dysphagia
Our activity support staff help our service users to prepare and eat meals every day, so it essential that they understand dysphagia. We also believe that people with an acquired brain injury have a right to enjoy their food as much as anyone else, and we try to normalise it as much as possible.

As part of our continuous training programme, our speech and language therapist recently delivered dysphagia training to support workers. They learned about the different stages of swallowing, what can go wrong at each stage and different diet and fluids that can be used to help manage the difficulties people have.

Our approach
Texture, colour, form and variety are important factors affecting the enjoyment of food, so considerable thought and care must be taken to ensure meals are appetising to people with dysphagia. Here are some the points that were covered in the recent training session.

• We take personal preferences into account as well as each individual’s physical abilities and risk factors
• Fizzy water mixed with fruit juice can provide an alternative to thickening for some service users
• Soft foods like salmon mousse and sweet potato pudding add interest and variety
• Meat and vegetables are blended separately so that each retains its individual flavour
• Strong flavours and foods like faggots and gravy blend well to create a tasty meal, which is served with separately blended vegetables
• Fruit smoothies or smooth vegetable soups provide tasty and nutritious thick drinks
• Cooked foods need to be checked before serving as they can change during the cooking process
• Sandwiches can be modified to a single texture using a soaking solution.

Jennifer Cranstoun, a Senior Care Worker who took part in the training session summed up our approach by saying: “You treat individuals as if they are your family. You want to serve them tasty, nutritious meals that they will enjoy.”