Question
How should I manage oral care for those patients who have severe cognitive impairment or patients who are bedbound?
Answer
Part of the process for managing oral care in those patients is a good assessment of the oral cavity as well as an assessment of cognition. That might be something in your facility that is done together with occupational therapy. We want to think about the patients ability to participate in terms of following directions, but also in terms of any visual perceptual deficits that might be getting in the way. Often if the speech pathologist and the occupational therapist can work together, we can determine if there is some equipment that might increase this particular patient's ability to participate in oral care. Are there some strategies and what degree of supervision is required here? How much can the patient do? I find that, particularly in skilled nursing facilities, I am often frustrated by this sort of dichotomy. Patients are either completely dependent for care or they are left on their own. If through our assessment we can find some middle ground, figure out how much of this task they are able to do and how much assistance they need, then maybe we could increase the overall participation.
Angela Mansolillo, M.A., CCC-SLP,BRS-S is a Speech-Language Pathologist and Board Recognized Specialist in Swallowing Disorders with over 20 years of experience. She is currently a senior Speech-Language Pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she provides evaluation and treatment services for adults and children with dysphagia and is involved in program planning and development for inpatient and outpatient programming including quality improvement initiatives, patient education, and clinical policies and protocols.
