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In April 2018, Ralph Fiala came to Life Care Center of South Hill in Puyallup, Washington, following a hospitalization due to aspiration pneumonia, general weakness and worsening chronic cough.

 

Fiala had difficulty chewing/swallowing and was recommended to be on a modified texture diet to help him swallow safely.

 

“Ralph felt discouraged and did not like the modified texture food and drink he was recommended to consume,” said Kate Schjoneman, speech therapist.

 

Even after Fiala went home with his wife in May, he was still eating modified texture food items and thickened liquids to keep him from getting pneumonia again. He agreed to continue working with speech therapy on an outpatient basis. At that time, his food was mechanical soft in texture and all of his beverages had to be the thickness of honey. His wife was very supportive and carried packets of thickener in her purse to restaurants and family events so that he could be safe while eating and drinking, but Fiala was very hopeful that he wouldn’t always have to do that.

 

During therapy, and at home, Fiala worked hard to complete his swallowing strengthening exercise program. He used postural techniques and strategies during eating/drinking and used a device in therapy sessions called the Iowa Oral Performance Instrument to make significant improvements in the strength of his swallow.

 

“The IOPI device assists patients with improving tongue strength and improved function of structures in the throat,” Schjoneman explained. “It provides a measureable target that is easy for patients to understand and motivating to achieve. This device was extremely valuable in his progress as it allowed for Ralph to see how hard he needed to work to make measurable gains by having visual feedback from the device.”

 

Fiala’s wife added, “I think he felt like it was a game and he thought, ‘How much can I do?’ He could see his progress. It’s something he can do and he can accomplish it.”

 

After working diligently in speech therapy for three and a half months, Fiala is now eating regular texture food items and thin liquids again.

 

“I needed [speech therapy], which I realized afterward,” said Fiala. “For me, speech therapy has been the answer for all of it.”