Chadwick Darren D, Jolliffe Jane, Goldbart Juliet
Department of Psychology and Speech Pathology, Manchester Metropolitan University, UK.
Int J Lang Commun Disord. 2002 Jul-Sep;37(3):345-57. doi: 10.1080/13682820210137196.
Dysphagia can have many negative health consequences for people with learning disabilities, including dehydration, aspiration and asphyxiation. Few studies have investigated dysphagia management among adults with learning disabilities. This study aims to contribute to the existing knowledge by investigating carer knowledge of speech and language therapists' (SLTs) recommendations regarding dysphagia management, and by comparing carer knowledge with their behavioural adherence to SLT recommendations. An exploratory study was undertaken investigating carer knowledge of dysphagia management strategies, along with a within-participants' study comparing carer knowledge and adherence. Structured interviews were conducted with carers supporting adults with learning disabilities and dysphagia to explore and ascertain their knowledge of dysphagia management. These data were then compared with observational data gathered in naturalistic contexts, assessing the behavioural adherence of these same carers. Recommendations pertaining to altering consistency and using specialized equipment and utensils were recalled significantly more readily than those concerning support and prompting for the dysphagic persons. Moreover, carers adhered to management strategies to a significantly greater degree than they could recall the details of the written guidelines containing the dysphagia management strategies. The findings suggest that tangible and routinely used management strategies, e.g. food and drink consistency, and use of specialized utensils, are easier for carers to adhere to and remember than support-based strategies such as verbal prompting and pacing. The discrepancy between compliance and knowledge can be explained by calling upon cognitive theories of memory and skill acquisition. This has implications for the selection of relevant outcomes of dysphagia training of direct care staff. Knowledge does not necessarily predict actual behavioural adherence and, though desirable, does not appear to be an adequate outcome indicator if the goal is behavioural adherence. Practice implications for SLTs training carers in dysphagia management strategies include combating fossilization of incorrect knowledge; encouraging carers to refamiliarize themselves with management strategies and their rationales periodically following initial training; and providing more specific contingency information for support and prompting in the guideline documentation.
吞咽困难会给有学习障碍的人带来许多负面健康后果，包括脱水、误吸和窒息。很少有研究调查有学习障碍的成年人的吞咽困难管理情况。本研究旨在通过调查护理人员对言语和语言治疗师（SLTs）关于吞咽困难管理建议的了解情况，并将护理人员的知识与他们对SLT建议的行为依从性进行比较，为现有知识做出贡献。进行了一项探索性研究，调查护理人员对吞咽困难管理策略的了解情况，同时进行了一项参与者内部研究，比较护理人员的知识和依从性。对支持有学习障碍和吞咽困难的成年人的护理人员进行了结构化访谈，以探索和确定他们对吞咽困难管理的了解。然后将这些数据与在自然环境中收集的观察数据进行比较，评估这些相同护理人员的行为依从性。与改变食物质地以及使用专门设备和餐具相关的建议，比那些关于对吞咽困难者提供支持和提示的建议更容易被回忆起来。此外，护理人员对管理策略的依从程度明显高于他们对包含吞咽困难管理策略的书面指南细节的回忆程度。研究结果表明，对于护理人员来说，切实可行且经常使用的管理策略，如食物和饮料的质地以及使用专门餐具，比基于支持的策略（如言语提示和节奏控制）更容易依从和记忆。依从性和知识之间的差异可以通过调用记忆和技能习得的认知理论来解释。这对直接护理人员吞咽困难培训的相关结果选择具有启示意义。知识不一定能预测实际的行为依从性，而且，如果目标是行为依从性，那么知识虽然是理想的，但似乎并不是一个充分的结果指标。言语和语言治疗师在吞咽困难管理策略方面培训护理人员的实践意义包括：对抗错误知识的僵化；鼓励护理人员在初次培训后定期重新熟悉管理策略及其原理；并在指南文件中提供更具体的应急信息以用于支持和提示。
