World Parkinsons Awareness Day - 11 April 2021

James Parkinson, English Surgeon, first described the effects of what we now know as Parkinson’s Disease. 
 
Parkinson’s New Zealand Website describes Parkinson’s as a progressive neurodegenerative condition. It is caused by insufficient quantities of dopamine – a chemical in the brain. Dopamine enables quick, well-co-ordinated movement. When dopamine levels fall, movements become slow and awkward. Parkinson’s has both motor and non-motor symptoms, and while it cannot be cured it can be treated.
 
As Parkinson’s is a progressive condition it can often take many years to develop and has little effect on life expectancy. Different people will experience a different number and combination of symptoms. 
 
Parkinson’s is relatively common. Approximately 1 in 500 people have the condition. It becomes more common with older age groups, and it is believed 1% of people above the age of 60 have Parkinson’s. The average age of diagnosis is 59.
 
Although there is a slight increase in risk of development of Parkinson’s in people who have family members with Parkinson’s, the risk is very low.

Although there is a slight increase in risk of development of Parkinson’s in people who have family members with Parkinson’s, the risk is very low.
 
Visit https://www.parkinsons.org.nz for more information
 
The following are some interesting talks relating to Parkinson’s:
 
“Deep brain stimulation is becoming very precise. This technique allows surgeons to place electrodes in almost any area of the brain and turn them up or down – like a radio dial or thermostat – to correct dysfunction. Andrea Lozano offers a dramatic look at emerging techniques in which a woman with Parkinson’s instantly stops shaking and brain areas eroded by Alzheimer’s are brought back to life”
https://www.ted.com/talks/andres_lozano_parkinson_s_depression_and_the_switch_that_might_turn_them_off
 
Listen to 'The chemistry of disease' on Radio New Zealand.
Guy Jameson has been awarded the Beatrice Hill Tinsley Medal for his work understanding the chemical structure of proteins that are important in diseases such as Parkinson's.
 
http://www.radionz.co.nz/national/programmes/ourchangingworld/audio/201815053/the-chemistry-of-disease

If you or someone you know is struggling with Parkinson’s Disease our friendly
therapists can help, just contact us on:
Phone: 03 377 5280 or email: admin@tpl.nz
​

World Autism Awareness Day - 2 April 2021
​Raising understanding and awareness of Autism Spectrum Disorders

Friday 2 April is World Autism Awareness Day and it falls during World Autism Awareness week (29 March – 4 April 2021).

Autism Awareness Week’s goal is to shine a bright light on autism, increasing knowledge of autism and the importance of early diagnosis and early intervention.

It celebrates the unique talents and skills of people with autism and is a week where individuals with autism are warmly welcomed and embraced in community events.

Autism New Zealand has a knowlegeable, professional staff who work daily with children and adults with autism and their support networks. Their main role is ‘essentially empowering people living with autism’.

What is Autism and Aspergers Syndrome?

Autism New Zealand’s definition is:

“Children and adults who have an autism spectrum disorder look the same as other people, and due to the invisible nature of their disability it can be much harder to create awareness and understanding.

Autism and Asperger syndrome still remain relatively unknown disabilities among the general population.

Yet it is estimated that autism spectrum disorders (ASD) are approximately four times as common as cerebral palsy and 17 times as common as Down's syndrome. ASD affects 1 in 66 people, approximately 65,000 New Zealanders, which is equivalent to the entire region of Otago.”

The following are some wonderful audio links around Autism which are well worth a listen:
 
“Autism Research - Dr Javier Javier Virues-Ortega” on Radio New Zealand.
 
https://www.ted.com/talks/ami_klin_a_new_way_to_diagnose_autism

There's no known cause ... and no cure. Autism remains one of the most complex disorders for researchers to tackle. But what if we could see inside the brains of sufferers to see if therapies are actually reshaping them? That's what a New Zealand team plans to do. It's a world-first study combining the latest behavioural science with cutting-edge functional magnetic resonance imaging (fMRI) technology. 

“Karen Pierce and Eric Courchesne - Early Detection of Autism” on Radio New Zealand.
 
https://www.rnz.co.nz/national/programmes/sunday/audio/201811139/karen-pierce-and-eric-courchesne-early-detection-of-autism
 
Karen Pierce and Eric Courchesne are directors at the University of California's Autism Centre of Excellence. Dr Pierce specialises in the early detection and treatment of Autism Spectrum Disorder (ASD) in toddlers, and Dr Courchesne's research has proved that the abnormal brain development causing autism begins in the womb. Karen Pierce and Eric Courchesne are the keynote speakers at Autism New Zealand's national conference later this month.
 
What's going on in the minds of children with neurological disorders?
 
https://www.radionz.co.nz/national/programmes/ninetonoon/audio/201817128/what's-going-on-in-the-minds-of-children-with-neurological-disorders
 
Susan Haldane is the head of Mind Over Manner - an organisation which uses the power of theatre to help people understand what's going on in the minds of children with neurological disorders like ADHD and autism.
 
 
‘'Professor Russell Snell - the hunt for autism genes” on Radio New Zealand
 
https://www.radionz.co.nz/national/programmes/saturday/audio/201837972/professor-russell-snell-the-hunt-for-autism-genes
 
Kim Hill (RNZ) talks to Professor Russell Snell, a world-renowned geneticist based at the University of Auckland who has long studied human disease genes and variations in genes in general with a focus on the molecular genetics of disease, in particular neurodegenerative diseases like Parkinson's and Alzheimers.  

Omega 3 Oils
 
There is limited evidence that fish oils (omega 3) reduce inflammation in some people with arthritis.  Omega 3 oil is also thought to reduce risk of heart disease.
 
It is recommended to have 1-2 servings of fish or other seafood a week for good health.  Omega oil is also found in flaxseed oil, walnuts and a small amount in red meats.

Vitamin Supplements 

If you are unable to achieve a healthy food intake, vitamin supplements may be necessary.  Talk with your Doctor about this.
 
Alternative Arthritis treatments 
​
Alternative treatments are available for many chronic diseases.  Discuss these with your Doctor before you try them as they may interact with your treatment.

Need more help? 
​
Therapy Professionals Ltd has experienced Dietitians who can provide group or individual nutrition education.  For Enquiries:  phone 377 5280.

Ways to Maintain Healthy Weight 

To lose weight
 
Even a small reduction in body weight will relieve stress on joints

• Replace sugar in drinks with artificial sweetener.
• Use trim milk ‘calcitrim’ milk.  This has less fat and more calcium than regular milk.
• If you enjoy a biscuit with a cuppa, have a plain, un-iced one, and have only one!
• Use tinned fruit that has no added sugar
• Use diet soft drinks or cordials
• Have small servings of meat, medium serve of potato and fill up on vegetables for the main meal
• Treats are for sharing.  Share a cake, dessert or sweet gifts.
• If you eat for comfort or company, write a list of other things you enjoy.  For example phone a friend, have a relaxing bath, listen to music, do an easy puzzle, go for a walk, pick flowers
• Exercise regularly for general good health

 
Ways to gain weight 
​
For some people, keeping weight on can be a struggle

• Have small regular meals with nourishing snacks inbetween
• Make sure everything you eat and drink is packed with good high calorie foods eg milky coffee, grated cheese on vegetables, butter on biscuits
• Consider having your main meal at midday if you get tired towards evening. Have dessert for afternoon tea or supper.
• Drink high protein milkshakes made with Complan or Sustagen powders.
• If cooking makes you tired, use convenience foods, for example, frozen meals, ready-made custard, cheese slices.  

If you would like advice from our Dietitians, call us, we come to you
 
                                    Therapy Professionals Ltd
                                    Phone No:     (03) 377 5280
                                    Email:             admin@tpl.nz
                                    Website:         www.therapyprofessionals.co.nz 

​
​
​Ageing and Down Syndrome
International Down Syndrome Day 21 March



​Adults with Down syndrome are living longer than ever before, now commonly reaching their 50’s 60’s and 70’s.  For this reason it makes sense to learn all we can about the unexpected challenges that may accompany growing older.
 
Many documents refer to adults with Down syndrome as ‘experiencing accelerated ageing'. What this means is, conditions usually seen in elderly adults (over 65) within the general population are being experienced by individuals with Down syndrome in their late 40's or 50's.  The reason for this is not fully understood, but is believed to be largely related to the genes on chromosome 21 responsible for Down syndrome which are also associated with the ageing process.
 
As we do not yet fully understand the ‘ageing’ process in adults with Down syndrome, predicting and preparing for this is challenging. Being aware of possible changes, and monitoring for early signs of these, will help with a proactive response.  Below are a few common signs of ageing in adults with Down syndrome:

Eyesight changes:

• Cataracts - causing clouding of the lens of the eye, which can make vision blurry and impaired.
• Keratoconus - where the cornea becomes cone shaped, distorting vision.

 
Diagnosis: Regular check ups with an Opthalmologist can help with early diagnosis.
 
 
 Hearing changes:

• Conductive Hearing Loss -  increased risk.
• Ear wax - Smaller ear canals can lead to build up of ear wax, impairing hearing. 

 
Diagnosis: 
Routine ear examinations for wax and periodic screening with an audiologist is recommended.
 
Undiagnosed vision and hearing problems are common and are frequently mistaken as stubbornness, confusion or disorientation. These can be greatly improved with glasses, hearing aids, removal of ear wax and environmental adaptions.
 
Hypothyroidism:
 
Common in adults with Down syndrome but frequently undetected. The thyroid gland is involved in various metabolic processes controlling how quickly the body uses energy, makes proteins and regulates hormones.
 
Signs and symptoms can include:

• fatigue 
• 'mental sluggishness' and/or confusion
• weight fluctuations
• mood changes especially irritability

 
Diagnosis and treatment:
It can be easily detected by a blood test and controlled with medication.

Obstructive Sleep Apnoea:
 
Leading to poor quality sleep which is not restorative. It can also put a strain on the heart and lungs and cause high blood pressure. 
 
Early signs include:                         

• snoring
• gasping noises
• daytime sleepiness
• morning fatigue
• excessive napping 
• fragmented sleep 

Later signs:

• irritability 
• poor concentration
• behaviour changes
• impaired attention

 
Diagnosis: Via a sleep study

Osteoarthritis:
 
Many individuals with Down syndrome have hyper flexible joints. Over time these can lead to increased wear and tear on the large joints (hips, knees etc.) causing osteoarthritis. Those who are or have been overweight are at a greater risk. Arthritis is painful and it can lead to:

• decreased mobility 
• poor fitness
• negative behavioural changes
• decreased willingness to participate in activities
• mood changes especially irritability

 
Treatment:     
Pain levels are often under reported so needs to be discussed with a GP or specialist if suspected.  Suitable pain relief is essential. 

Osteoporosis:
 
A thinning of bone mass leading to the risk of fracture. Adults with Down syndrome are at a higher risk for disease especially if there is:

• immobility 
• low body mass
• family history of osteoporosis
• early menopause
• long time exposure to certain anti-seizure medications

 
Diagnosis:  A bone density scan and can be treated with medication, exercise and diet.

Atlantoaxial or Cervical spine (neck) instability:
 
Instability between the first and second spinal bones directly below the base of the head, If instability is present and arthritis changes occur in the spine, there is increasing risk of damage to the spinal cord in that region. The bones of the neck are more vulnerable as adults with Down syndrome grow older.
 
Symptoms include:

• weakness in the arms or hands
• walking abnormalities
• incontinence

 
Diagnosis: 
A screening cervical spine x-ray is generally recommended at least once during adulthood.

Coeliac disease:
 
Where one’s body cannot digest gluten present in wheat products, causing damage to the lining of the intestine and preventing absorption of certain nutrients causing:

• gastrointestinal distress
• nutritional deficiencies
• general irritability
• behavioural changes

 
Diagnosis:
Screening can be done via a blood test, but formal diagnosis requires a biopsy of the small intestine. 
 
Treatment:
Dietary modification
 
Alzheimer’s:
 
A type of dementia that gradually destroys brain cells affecting:

• memory
• ability to learn
• make judgment 
• communicate 
• carry out basic daily activities 

 
Early onset Alzheimer’s disease is more common in adults with Down syndrome as they both share a genetic connection on chromosome 21. The risk of developing Alzheimer’s disease increases with age, although it is not inevitable that people with Down syndrome will get Alzheimer’s. It is helpful to have a good baseline of basic self-care skills, personal achievements, academic and employment milestones and other skills for comparison as changes are observed.
 
Diagnosis: clinical judgment based on an accurate history. 

Reference:        
National Down Syndrome Society NDSS Aging and Down Syndrome Health and Well-being Guide. 

About Osteoporosis - Moving Safely

Good posture and proper body mechanics are important throughout your life, especially if you have osteoporosis. “Body mechanics” refers to how you move throughout the day.
 
 
Safe Movement
 
Knowing how to move, sit and stand properly can help you stay active and prevent broken bones and disability. Proper posture can also help to limit the amount of kyphosis, or forward curve of the upper back, that can result from broken bones in the spine.
 
One of the most important things about body mechanics and posture is alignment. Alignment refers to how the head, shoulders, spine, hips, knees and ankles relate and line up with each other. Proper alignment of the body puts less stress on the spine and helps you have good posture.

Unsafe Movement
 
To keep proper alignment, avoid the following positions or movements:

• Having a slumped, head-forward posture
• Bending forward from the waist
• Having a slumped, head-forward posture
• Bending forward from the waist
• Twisting of the spine to a point of strain
• Twisting the trunk and bending forward when doing activities such as coughing, sneezing, vacuuming or lifting
• Anything that requires you to reach far.  An example is reaching up for an item on a high shelf, which also could cause you to lose your balance and fall.

Some exercises can do more harm than good. If you have osteoporosis or have had broken bones in the spine, you should avoid exercises that involve bending over from the waist. Some examples include:

• Sit-ups
• Abdominal crunches (also referred to as stomach crunches)
• Toe-touches

 
Many exercises and activities such as yoga, Pilates, tennis and golf may need to be avoided or modified because they often involve twisting and bending motions. Bending forward during routine activities also puts stress on the spine and can increase the chance of breaking a bone in the spine. While bending forward puts strain on the spine, it is usually safer if you’re able to keep your back flat.

• Sit-ups
• Abdominal crunches (also referred to as stomach crunches)
• Toe-touches

 
Many exercises and activities such as yoga, Pilates, tennis and golf may need to be avoided or modified because they often involve twisting and bending motions. Bending forward during routine activities also puts stress on the spine and can increase the chance of breaking a bone in the spine. While bending forward puts strain on the spine, it is usually safer if you’re able to keep your back flat.

Sitting

• When sitting in a chair, try to keep your hips and knees at the same level. Place your feet flat on the floor. Keep a comfortable posture. You should have a natural inward curve to your lower back and a tall, upright upper back.
• When sitting in bucket seats or soft couches or chairs, use a rolled up towel or pillow to support your lower back.
• When standing up from a chair, move your hips forward to the front of the chair, and use your leg muscles to lift yourself up.
• When driving, use the head rest.
• When tying your shoes or drying your feet, sit in a chair. Place one foot on a footstool, box or on your other leg. Lean forward at the hips to tie or dry. Do not bend over or slouch through your upper back. Keep the natural curve of your lower back and a straight upper back.
• When reading, do not lean or slump over. Set your reading material on a desk, table or on pillows on your lap.
• When sitting at a desk, prop up a clipboard so it slants toward you, like a drafting table.
• Use a footstool or footrest when seated for long periods of time.

Standing

• Keep your head high, chin in and shoulder blades slightly pinched together.
• Maintain the natural arch of your lower back as you flatten your abdomen by gently pulling it in.
• Point your feet straight ahead with your knees facing forward.
• While standing in one place for more than a few minutes, put one foot up on a stool or in an open cabinet (if you are in the kitchen). Switch to the other foot every so often. You’ll find this much less tiring for your back and legs.

Lying Down and Getting Out of Bed

• When lying on your side in bed, use one pillow between your knees and one under your head to keep your spine aligned and increases your comfort.
• When lying on your back in bed, use one or two pillows under your knees and one under your head. Try to avoid using extra pillows to prop your head and upper back since this will put you into a rounded upper back position. But, if you have a rounded upper back posture with a forward head, you may need two pillows to support your neck comfortably.

 
When getting out of bed, reverse the steps you used to get into bed (above):
​

1. Keep both arms in front of you.
2. Pull your abdomen in and breathe as you roll onto your side.
3. Keep your abdomen pulled in and use your hand to raise your upper body as you carefully place your legs over the side of the bed in one motion.
4. Sit on the edge of the bed for a moment or two before you stand up. 

​When on your back, never lift your head and upper back to sit up in bed or get out of bed.

​ 
Ref:  National Osteoporosis Foundation USA

About your abdominal muscles

Our abdominal (stomach) muscles are critical in supporting our backs. It is very important to keep them strong.
 
We have four layers of abdominal (stomach) muscles, the rectus abdominis, external oblIques, internal obliques and transversus abdominis.  The first three of these muscles are vital for support of your lower back. They act as an inbuilt corset and are the majority of muscles that make up your core muscles.
 
To protect your back from injury keeping your core muscles strong is very important along with ensuring when you’re handling loads you lift without twisting and losing the curve of your spine.   If you want to protect your back from injury here is a simple way to strengthen your abdominal muscles.

Here is an exercise you can try to improve your abdominal strength. 
 
Sitting on a dining chair try lifting both feet just off the floor while your hands push down on the chair seat just beside your legs.   (See diagram).  
 
Hold for a few seconds and increase the time, as your muscles get stronger.
 
Practice four times before each meal perhaps!
 
NB       Remember to breathe normally – do not hold your breath

Notice how your stomach (abdominal) muscles feel while doing this exercise so you will know when trying the following.
 
Now you can practice bracing your abdominal muscles in any position – sitting, lying, standing, or walking.
 
Try doing it while doing everyday activities like vacuuming, standing doing the dishes, sitting watching the TV, lifting anything and while you do exercises and stretches. 
 
It’s particularly useful to brace these muscles while lifting, or carrying anything with a little weight especially children.

Strong abdominals help your back and as well as your figure!
 
If you are having trouble doing this exercise or have back pain, you don’t have to struggle alone.  Our friendly physiotherapists can help.
 
Just contact us 
 
            Ph:                             03 377 5280
            Email:                         admin@tpl.nz
            Website:                    www.therapyprofessionals.co.nz

Communicating with Technology

Sometimes people with disabilities have problems communicating even their basic needs and wants.  This is frustrating for them and those around them.
 
Communicating is a complex task, which, at its most basic level, is about understanding and being understood. There are many components to the process of communication, like understanding and using:
 

• Non-verbal communication e.g body language, facial expression, signs, writing, pictures and drawings
• Verbal communication
  

            -  making speech sounds
            -  words and sentences (Ianguage)

• Social rules e.g turn taking, listening and staying on topic

 
If someone has a problem with any of these areas then it can make communication difficult. A speech Language therapist is skilled in identifying where the break down in communication occurs and finding solutions to these problems.
 
The use of technology can help some people struggling to communicate however not everyone. Others may benefit more from low-tech solutions.  Independence can be enhanced with the use of technology too. For those who technology would help Speech Language Therapists can help with:
 

• identifying what sort of communication method would best assist the person communicate e.g. switch, iPad and software.

• giving advice and support to those around the young person on the use of communication devices or switches to interact and communicate.

 

• referring to Talk Link for assessment.

 

• training support people to use a communication device as part of the person’s daily routines.

 

• supporting the client to use their communication device so they become an independent communicator e.g. when ordering food and drink

 

• developing a low tech option should the technology fail.

​

• Use of switches to: 

 

• communicate e.g. greet people

 

• assist with independence e.g. to operate a CD, turn on a blender. 

 
 
Therapy Professionals Speech Language Therapists are experienced working with people of all ages and many kinds of disabilities. Whether you are older having had a stroke or you’re a child with an intellectual and physical disability we can help.

 If you need help with a communication problem our friendly Speech Language Therapists
can help,  just contact us.
 
                                              
Phone   3775280
         Email     admin@tpl.nz

Teaching Crossing the Road Skills
For most adults, crossing the road is automatic behaviour, we do it without thinking and we don’t consider how complex a skill crossing the road is. Nor do we consider how our life might be curtailed if we couldn’t successfully negotiate our way around roads.
 
Some of the skills required for crossing the road include:
 

• determining when it is safe to cross. This requires the ability to observe your environment.
• identifying moving cars, as different from stationary vehicles
• identifying signals at crossings that let you know it is safe to cross.

​In some cases even more advanced problem solving is required.  For example, if the traffic light signals say it is safe to cross and a motorist continues through the intersection, we need to be able to identify the car is not stopping and decide to wait for it to pass before crossing.
 
Traffic-related mishaps account for a large number of deaths and injuries amongst our society’s children and youth. For youngsters with special needs, the risks can increase dramatically due to:

,Acquiring these skills is important for our independence and quality of life.  For those of us with special needs, who struggle to learn road skills easily, this can be a big barrier to independence.  
 
Parents, educators and support workers need to work much harder to teach young people with special needs about street and traffic safety and employ strategies to help compensate for the challenges they may face. The first step is to break the skill down into its separate skills and teach each of these skills step by step.
​
If you are struggling to teach a young adult to cross the road and would like some help our friendly Occupational Therapists at Therapy Professionals Ltd can help.  

Enable Equipment Service
 (Ministry of Health Funded Equipment Management Scheme)
 
If you’re in need of equipment to assist you to function in life, you may be eligible for Enable equipment.  The equipment is on loan from the Ministry of Health free of charge, however the assessment and application may cost you, so please discuss with a therapist.
 
Therapy Professionals Ltd’s Physio and Occupational Therapists are accredited assessors for Enable equipment in the following areas:
 
1.  Personal Care & Household Management  
​
     a)   Personal equipment to enable you to carry out personal care activities in their home, at work
           or place of study, such as:
             -  eating and drinking
             -  personal hygiene (washing and toileting)
             -  getting dressed
             -  transferring from the bed or chair
             -  getting in or out of the home 

      b)    Household Management equipment to enable you to carry out essential 
              household tasks to return to, or remain safely your home, such as the preparation of food
              and drinks, if you live alone or by yourself for much of the day.

2.   Walking & Standing 

    a)  Walking equipment to support you with walking and transferring.    

    b)  Standing equipment to support you to maintain a good functional position
         and body alignment in standing.  

3.  Basic housing modification equipment to ensure your safety at home such as: 
     -  handrails,
     -  wedge threshold ramps
     -  lever taps or 
     -  internal door widening. 

4.  Complex Housing Modifications are where the alterations to the structure of the property are
      made. 

5.  Wheeled Mobility and Postural Management Level 1 and credential lying advice and
​     recommendations related to wheeled mobility, seating and postural management. 

The Process: 
 
It takes between two hours and several months depending on the complexity and expense of the equipment. 
 
   -  an Enable accredited therapist assesses your need for equipment and if you’re eligible. 
   -  Therapist completes the Enable service request electronically if funding is ‘available’.  While
      funding may be available, Enable has final discretion on eligibility for equipment. 
   -  Equipment is trialed or issued to you. 
   -  The therapist will follow up on the use and appropriateness of the equipment. 

Keeping Records of Equipment 

Most equipment comes with an ASSET NUMBER. You or the residential providers are responsible for keeping records of asset numbers and maintenance of the equipment. 

The asset number stickers can fade and come off especially on soft fabrics, eg slings. We recommend you develop a system to record asset numbers permanently. (eg: taking a photo of the piece of equipment and asset number.  Keep it somewhere safe or in your client’s file). 

Repairs and Maintenance: 

Contact one of the subcontractors listed below: 
 
    More Mobility/ Mobytech Ltd
            113 Blenheim Road, Christchurch 8041
            
            Phone:            (03) 348 3460 Option 3 or 027 516 2340                    
            Email:             repairs@mobytech.co.nz                                                                                                                                                                                                                                                                            
                                    christchurch@moremobility.co.nz
            Website:         http://www.moremobility.co.nz 
 
 
    Personal Mobility Systems (Wheelchair Services (SI) Ltd)  (not generally a mobile service) 
            29 Shakespeare Road, Christchurch 8240 
 
           Phone:        (03) 366 8815 or 0275 383 584, Free: 0508 662 454 
           Email:           admin@mobilitysystems.co.nz
           Website         www.mobilitysystems.co.nz
 
    Rehab Enterprises, mobile workshop.
         Contact Owen Henwood on phone: 027 230 5974 or email: owenhenwood@live.com 
 
Alteration or Modification of Equipment

If you wish to have equipment altered or modified this is not a repair or maintenance. Call the therapist. 
 
 
Equipment no longer needed for clients:

Ring Enable and ask for it to be picked up                  Phone: 0800 171 995 
 
OR 
 
Residential providers - If another client would benefit from the equipment, call the therapist, they will assess and if suitable re-issue the equipment. 

​Eating and Drinking Problems related to Dementia
 
A number of eating and drinking issues may occur for those with dementia including under or over eating and swallowing problems. Swallowing difficulties (dysphagia) related to dementia and Alzheimer’s have increased with longer life expectancy.  The prevalence among those individuals with intellectual disability is also increasing, however at a younger age as they prematurely age.
 
 
Swallowing difficulties:
 
How do you know someone has an eating and drinking difficulty?

They will have some or all of the following signs while or after eating and drinking:

• coughing and choking
• food or fluid spilling from the mouth. 
• food/fluid being gulped down too quickly.
• food/fluid coming out of the nose.
• refusal to eat
• long time taken to eat and drink or refusal of favourite foods
• wet or gurgly voice 
• food staying in the mouth after the swallow
• dribbling
• recurrent chest infections
• weight loss, dehydration or weight gain

Under-eating

As we age our appetite decreases.  For those with dementia this decrease in appetite can be more pronounced. In the early stages under-eating can be prompted by depression and later on due to forgetting to eat or even how to eat. Medications can affect appetite too.

Suggested support
 

• visit a dentist and make sure teeth and/or gums aren’t sore and dentures fit
• review medications
• prepare appetising food high in colour and smell
• offer finger foods, they may be more easily managed

• offer food little and often throughout the day may be more beneficial than three big meals
• exercise - this can help make people feel hungrier so therefore they will eat more

 Over-eating:
 
For some people with dementia an increase in weight can be an issue for a number of reasons.  They:

• forget they have eaten.

• eat too much - as they are not aware of feeling full
• have cravings for lollies or chocolate
• are bored
• have reduced their exercise
• are on medications that affect appetite and weight gain

Suggested support:

• limit access to sweets or disguise unhealthy snacks behind plain wrappers.
• substitute healthy alternatives.
• nutritious snacks or finger food throughout the day with smaller main meals
• plan activities to decrease boredom.
• review medications.

Safety:

• cooking for themselves - watching for burnt pots, under or uncooked food
• meals on wheels or other options may be a safer option

 
The role of the team and when to refer:

• GP – review of medications
• Dentist – ensure teeth and gums are healthy/dentures fit
• Speech-Language Therapist – assessing for swallowing problems, modified diet and fluid and textures prescription
• Dietitian – supplement and dietary advice
• Occupational Therapist – eating and drinking utensils
• Physiotherapist - exercise

If you need help with someone with a swallowing problem, just contact us at Therapy Professionals Ltd, our friendly Speech Language Therapist can help.
 
                                    Phone:                       03 377 5280
                                    Email:                         admin@tpl.nz
                                    Website:                    therapyprofessionals.co.nz