QUENCHING YOUR THIRST

QUENCHING YOUR THIRST JAMAICA GRANTIS, MSWA SPEECH PATHOLOGIST VOICE BANKING LAURA RYAN, MSWA SPEECH THERAPY ASSISTANT As we move into the warmer weather of summer, it is increasingly important we are all mindful of staying well hydrated. Maintaining adequate hydration can be challenging if you are a person living with dysphagia (swallowing difficulties), especially if your swallowing difficulties require you to drink thickened drinks. What are thickened drinks? There are two kinds of thickened drinks; those considered ‘naturally thick’ (eg a milk shake or smoothie), and those we prepare by mixing a thickening agent to a regular or thin drink, so that it thickens artificially. Thickened drinks are usually recommended by a Speech Pathologist if a person is shown to be aspirating thin drinks; that is, thin fluid is entering the lungs while drinking. Aspiration can potentially lead to aspiration pneumonia. Thickened fluids may help to reduce a person’s aspiration risk by slowing down the flow of liquid, allowing a person more time to organise and coordinate a safe swallow. There are different levels of thickened fluids, ranging from slightly and mildly thick, to moderate and extremely thick. Each level can be tested to ensure it meets the right consistency, or viscosity, for safe swallowing. Did you know? If you have been recommended to drink thickened drinks, this usually means that all liquid you consume should be thickened, including the broth in your soup, or the milk in your cereal. It might also mean that you find it difficult to eat juicy foods such as watermelon or oranges. People who drink thickened drinks are at higher risk of dehydration Dehydration can lead to side effects such as headaches, dizziness, dry skin, fatigue, cognitive difficulties, and other more serious health concerns. There are many reasons why it might be harder for someone who drinks thickened drinks to meet their recommended daily fluid intake. For example, thickened drinks: • are ‘heavier’ and can leave you feeling fuller quicker, so you tend to drink less • take longer to flow through the mouth and throat before being swallowed; they can also be harder to suck through a straw and may need to be ‘drunk’ from a spoon – so it often takes longer to finish a thickened drink • may taste or feel different in the mouth – some thickened drinks leave behind a mild coating in the mouth, and if not prepared properly, could be a little lumpy, so some people might find them unsatisfying to drink so they tend to drink less • can sometimes be more expensive, leading some people to only drink what they can afford Thickened fluids aren’t always safer Thickened fluids tend to leave behind some residue in the mouth and throat after swallowing, and this residue can sometimes be aspirated into the lungs after swallowing. It is usually safer to aspirate thin/regular water than to aspirate a drink mixed with a thickening agent. The MSWA Speech Pathology team considers thickened drinks a last resort Our goal is to help MSWA Members swallow as safely, efficiently and comfortably as possible, without modifying or restricting usual eating and drinking habits. To do this we explore all other options first, before going down the path of trying thickened drinks. For example, do changes to a person’s drinking posture help them to swallow with more ease? Does the use of mindful swallowing strategies help a person to swallow with more control? Are there adaptive cups or straws we could try that help to better control the delivery of fluid into the mouth, allowing a person to swallow with greater safety? These and many other options should be explored before recommending thickened fluids. Thickened fluids aren’t always forever Sometimes a Speech Pathologist might recommend a person drink thickened drinks following a serious hospital procedure, dental surgery, or a short-term exacerbation of MS symptoms. Sometimes thickened fluids are recommended only during times of extreme fatigue. The Speech Pathologist’s role is to monitor and regularly review whether thickened fluids are required long-term. Thickened fluids aren’t all bad though For most, thickened fluids help to improve swallow safety and maintain hydration. If you are having difficulty drinking thin or thickened drinks, please contact the MSWA Speech Pathology team on 9365 4888 for advice and support. Similarly, if you would like to discuss whether thickened drinks are appropriate (or possibly no longer appropriate) for you, please contact the MSWA Speech Pathology team. I have donated my voice. Not a sentence I thought I would ever say. Being a therapy assistant in the MSWA Speech Pathology Department suits my personality perfectly. Every day I am helping people, by implementing a therapy program to help people with their communication devices. These communication devices enable people, that might otherwise be unable, to express their thoughts and emotions. They empower people to share their opinion, initiate conversations, tell jokes, instruct others and much, much more. Picture the late Steven Hawking if you don’t know anyone who used one. When setting up a communication device, you can often pick from several pre-recorded voices, male or female etc. This is great, however, they usually don’t sound anything like you. This is where ‘voice banking’ comes in, not to be confused with message banking, which is recording a sentence to be played back exactly as it was recorded eg. “I love you sweetie.” Voice banking is recording a sample of your voice to create a unique synthetic voice that can then be used with these communication devices. The quality of the finished synthetic voice depends on the number of sentences and the quality of the voice recorded. So, it’s crucial to complete the recordings early on even if you think you might not need it. Recording your voice can be a lengthy process, recording anywhere between 400 – 3,200 sentences, the more you record the more personal the synthetic voice will sound. It’s advisable to complete the recordings over several sittings, such as a few sentences at the same time each day so this can take several weeks or months to complete depending on your fatigue levels and other commitments. So, it’s strongly recommended that you begin voice banking as early as possible. Once you have completed the recordings you can listen to your synthetic voice before deciding if you would like to use it. What if it’s too late? If you’re unable to record the sentences but have a close relative who sounds like you, they might be willing to do the recordings and ‘donate their voice’ for your use. Because synthetic voices sound slightly robotic in nature you won’t sound exactly the same as each other. I recorded 3,155 sentences, which seemed never-ending whilst recording them, however, I was intrigued to hear what a synthetic me would sound like. I had a listen after 650 sentences and I was really impressed, it definitely sounded like me. The more I recorded the better it got but I would have been very happy using it at that level had I needed to! So, my synthetic voice is now available for people to use on their device, who knows one day I might bump into someone using it, wouldn’t that be amazing! I might even need it myself or it will never be used by anyone, but I will have had the experience of recording it to assist others through the process. Interesting fact: Stephen Hawking’s voice, ‘Perfect Paul’, was derived from recordings of Dennis Klatt, an American researcher in speech science and the pioneer of computerised speech synthesis. Dennis recorded his own voice when developing the software and this became the voice you heard when listening to Stephen Hawking. Dennis Klatt later lost his voice to cancer prior to his death in 1988. 26 | MSWA BULLETIN SUMMER 2018 MSWA BULLETIN SUMMER 2018 | 27