DMR MEDICAL ADVISORY #98-7
APPENDIX I
SUMMARY OUTLINE

Persons at Risk for Aspiration

  • Profound Physical Disabilities, lacking skills in self care, gait, and posture control
  • Coughing,, spitting, or choking while eating
  • Recurrent vomiting
  • Recurrent pneumonias

Evaluation

  • Involve Individual/Guardian/Family in process
  • Speech and swallowing evaluation with a modified barium swallow
  • Upper GI X-ray to assess for gastroesophageal reflux, or identified esophageal damage on endoscopic evaluation

Recommendations

  • Swallowing and eating program with monitoring of symptoms
  • If unable to maintain nutritional support safely, consider gastrostomy feeding tube.
  • If symptoms persist, despite gastrostomy feeding tube, consider either conversion to a jejunostomy feeding tube or fundal plication.