Types of diet/fluids offered as oral trials
There was a lack of consistency in the types and quantities of oral
trials offered and no standard approach was identified to guide
decision-making around oral trials offered. Interestingly, one
individual who was on full meals but NBM for fluids was documented as
‘oral trials’, showing inconsistency in terminology and delivery of this
approach. Some recommendations gave more precise recommendations such
as, ‘5 sips’ whilst others left more breadth in recommendations, for
example ‘10-15 teaspoons’. There is a general lack of uniformity in
treatment strategies in the SLT community, which is evident both in
treatment approaches and intensity of treatment 6,25.
The range of quantity and type of oral trials recommendations may
reflect clinical judgements regarding how to provide adequate challenge
or ‘load’ to the swallow system. Different viscosities and volumes of
boluses have been found to provide specific sensory input, which
consequently affects the nature of swallow physiology by altering the
load, intensity or volume of exercise 26. This is the
mechanism behind the McNeill Dysphagia Therapy Program (MDTP) which
focuses on the use of swallowing as an exercise and involves offering
food or fluid boluses of varying viscosity and volume in a hierarchical
fashion to improve strength and skill of swallowing27. Decision-making is often informed by
‘practice-based rules’ which are established through experience28 and, although there is no evidence-base to guide
decision making within oral trials, there may be a range of unwritten
rules established. Further research is indicated to explore this.