When walking-walk. When eating, Eat-10

Speaker1:
[0:15] Hi, everyone. I'm Emily.

Speaker0:
[0:17] And I'm Eva.

Speaker1:
[0:18] And you're listening to Speech Talk.

Speaker0:
[0:21] We are your research book club so you can do evidence-based practice in practice.

Speaker1:
[0:25] So let's get talking. Today, we are taking a look at the dysphagia screener, the eating assessment tool, or Eat10, as we know and love it. The Eat10 is a dysphagia screener for adults that gives insight into dysphagia types and how their dysphagia affects them.

Speaker0:
[0:41] You know, I think I wrote that we know and love it because I wanted to feel more like I loved it. I almost never use it. It's like the neglected child of the dysphagia screeners, but it's actually really useful, which is what we learned this week. So we read the article, A Prospective Study for Evaluation of Structural and Clinical Validity of the Eating Assessment Tool by Mahler, Safa, and Ostberg. And what it tells us is that, first of all, how the E10 works, which is that it is a self-assessment rating scale where the patient rates their performance from zero, meaning no deficits, to four, meaning severe deficits, across 10 different questions. You as the clinician gather all the reported answers and total them. If they get a score of zero, they have zero deficits. If they get three or higher, it's considered clinically impaired. And the highest or most severe score they can get is a 40, which means eating is terrible. I don't know what to tell you. We don't know how you've been eating. It's awful. Emily, tell us a little bit about how it was set up.

Speaker1:
[1:47] So this study, they looked at 200 participants. It was pretty equal across gender, and they looked at people aged 22 to 94.

Speaker0:
[1:57] Like a big range.

Speaker1:
[1:59] A huge range. You are an adult. You participate.

Speaker0:
[2:03] You're basically like legal adult to grave. You qualify.

Speaker1:
[2:07] It's like, on your way out, take this questionnaire.

Speaker0:
[2:10] They're like petitioning hospice, like, hey, that guy, B-Bed.

Speaker1:
[2:15] So the participants responded to the 8-10 questionnaire. error, then they underwent a fees examination to look at how their scores correlated with the swallow function, and then they're grouped by their dysphagia category, which we will explain more in a second.

Speaker0:
[2:29] Yeah, and we thought this was pretty useful because, one, it does tell us that the EAT-10 is a valid tool. There had previously been some research that said maybe it didn't have structural validity, but the researchers address some concerns they had with that original research It also shows that the EAT10 results can correlate pretty well with the two dysphagia categories Emily mentioned, neurodysphagia and esophageal-slash-structural dysphagia. And it teaches us as clinicians about how dysphagia is impacting our patients, which is always a boon for patient-centered care approach. So Emily, tell us a little bit about the neurodysphagia category.

Speaker1:
[3:13] So neurodysphagia, we're thinking most of our caseload typically, right? We have our strokes, our Parkinson's, our MS, anything where your neurons are not firing in the right way to get your swallow to be perfect. So this group or category of people, they ranked six measures as affecting them the most. Those including decreased ability to go out for meals, they had increased difficulty swallowing salads,

Speaker1:
[3:41] A decreased pleasure of eating, they reported food sticking in their throat, coughing when eating, and swallowing as being stressful. I always thought this food sticking in your throat is important too in this piece because we always learn that food sticking in your throat is like your clinical sign of an esophageal issue. But I thought that was interesting that it was a neurodysphagia thing too because a lot of times they'll get ruled out of our caseload if they have food sticking. Like, oh, it's just, it's something going on with their esophagus. But this tells us don't automatically rule them out. Then we go into structural or esophageal dysphagia. So we're thinking dysmotility, a diverticulum, cancer, or maybe a stricture. And they ranked these four measures as affecting them the most, which were preventing them from going out, food sticking, decreased pleasure with meals, with food sticking being the highest rated. So yes, food sticking is very aligned with that GI, but it's still important in neuro. Yeah.

Speaker0:
[4:48] And again, we're seeing some of the same measures across neuro and structural slash esophageal. But the difference between them is that in general, structural esophageal in the self-report was ranked higher. So people felt that the assessment measures almost entirely across the board for all 10 questions more severely impacted them than people who self-rated with a neuro etiology for dysphagia. With one exception, number nine, coughing when eating. People with neuro dysphagia self-rated that as impacting them more heavily than people with, structural esophageal dysphagia. Items 1, 3, and 5 on the E10 really had no difference between the two groups. They had very similar self-reported impact.

Speaker1:
[5:41] And as a reminder, 1 being they feel like they're losing weight because of their dysphagia, 3 being liquids take more effort, and then 5, pills take more effort.

Speaker0:
[5:56] Oh, I love that you wrote all those out. Maybe at the end, we should just read through them in case our listeners are not actively listening with a printed out version of the E10 in front of them.

Speaker1:
[6:06] We should probably give that as a caveat. Like, please have your resources ready for this extra informative class. Informational. Yeah.

Speaker0:
[6:17] And one of the great things, Emily and I are really big fans of things that are really quick. We all know that things can get chaotic, particularly in sniffs. And I'm sure that's the same for our hospital friends. But having a quick screener that you can do is always a fantastic option for that reason. If you go in, the person has pooped themselves, they need to be changed, and we're well into our session time, and you still haven't even had the chance

Speaker0:
[6:43] to really do anything swallow-related, the E-10 should be able to be completed in about five minutes. That being said, that requires somebody who can cognitively pay attention, who is a reliable historian. And Emily and I love to talk about our COG patients. They're so important. And so many standardized assessments don't work for them.

Speaker1:
[7:07] No, and this actually just happened to me the other day. I was seeing a patient. All of the things were going on with this patient. Bipolar, schizophrenia, all of those things. And I was talking with them about their coughing on their fluids and throwing up. And he was like, oh, yeah, no problems, no problems. I'm like, but what is this I'm seeing? And until I talked to their family, like, oh, yeah, they are always coughing. There's always something going on. And so I ended up definitely picking up on caseload just to address those things. But it is funny, like some of those diagnoses, even outside dementia, really impact our patients from being accurate historians. and reliable people.

Speaker0:
[7:58] And somewhat hilariously in the opposite direction, we have this guy in the building who is always hustling for crackers. He is on a pureed diet. He constantly is just having difficulties. And for a while they did get really severe, but he is not a reliable historian. I go into the activities room or time and he's like, I miss, I miss, I miss. I am currently choking. And I was like, so you're talking to me. And I was like, do you feel like there's something that's stuck in your throat? And he's like, I am like suffocating. I was like, no, no, you're not. And let's get a little more accurate. Like, how bad do you feel like the food is stuck in your throat? He's like, I can't breathe. And I was like, again, you're actively talking to me, so you can breathe. And he's just sitting there in his wheelchair upright, does not have any look of distress on his face. He's like, I can't believe you won't help me. Insert a lot of cuss words that I'm not going to say in your podcast. I was just like, it was really hard for me to understand the severity of the situation when what you're saying has no relationship to what I'm seeing. And then he proceeded to continue to eat the crackers, where I don't know where he got them from.

Speaker0:
[9:16] And yeah, but then like a week later, he was pouring water out of his nose when he was drinking. So like obviously there was something horribly wrong, but he could not describe what was happening. So the accurate historian aspect is quite important for the E-10. And on that note, the authors actually made a comment about this, which is that in terms of the structure of the E-10, if people had errors or inconsistencies in reporting, it wasn't that they were answering the wrong questions or weren't appropriately participating, but they had a tendency for extreme responding. So yeah we we've all seen that happen where a patient is like oh yes the worst thing ever i can't i can't even swallow and you're like you're eating lunch all that food has gone down so when you say you can't even swallow please tell me more about what you mean right.

Speaker1:
[10:11] I like i like that too for this study because like i would rather have someone tell me like they're dying and be like, okay, like, let's, let's figure this out. Then someone like actually choking on something and like, no, that didn't happen. I'm fine. And then you're like, no way. But like, that was really bad. Do you hear it? Like, no, no, I know. I'm fine. I have no problems. Let me go. And you're like, well, I can help you. I promise. Like, no, it's good. It's good. Everything is kosher. We are good to go.

Speaker0:
[10:48] I had a COPD guy like that. He had like pharyngeal level impairments that we were eventually able to get a fees in to see what was going on. But like when his COPD was so severe, I thought it was just, like a insufficiency with like breathing and airway protection that was going on. But it turns out like there was motility problems with his airway as well. So like the piriform sinuses were just catching a ton of stuff. And that's why it sounded like he was actively drowning whenever he was eating and drinking. It was just like this wet, gurgly voice and it sounded terrible. And he would just cough like nobody's business. And I was like, you sound like you are at death's door every time you eat. And so I downgraded him. He would cuss me out like every time I went into the room. He's like, you're the person responsible. Except the word he used to is not person. He's like, I hate you. I was like, okay, but do you notice that you have problems eating? He'd be like, I don't know what you're talking about. And I was like, so this is where you and I just can't see eye to eye. When I see you eat and drink, I think it sounds like we're going to have to send you to the hospital and you think this is completely fine and normal. It wasn't. The fees revealed, though, that it was the same across all textures. So he could go back to regulars, you know, because it was just as bad as you were.

Speaker1:
[12:14] And you put your head between your legs. It's a tari.

Speaker0:
[12:21] If only I kept him on regulars, I could have avoided a lot of verbal abuse. But, But, you know, what you going to do without a fees?

Speaker1:
[12:29] Well, I'm glad that your facility agreed to get you one because sometimes those can be tough. Different podcast.

Speaker0:
[12:38] Yeah. Quick plug for Carolina Speech Pathology. They'll do mobile fees if they're in your area. They're great. Love those guys. And they'll do fees training. They're so good. But coming back to, like, why should we look at the EAT-10? I think for a lot of our other screeners like the Yale and the Tumas or Thomas, however you like to say it, I don't know. It's really the only one that gets at how people feel about their dysphagia and how they experience it. And in terms of like goal writing and development of plan of care, that's so important, you know, that having somebody say, I want to experience less, you know, stress when eating or I want to make sure I'm not losing weight as much or I want to have more pleasure with eating. You can now put a number on that, which is great because we all know that that makes for good clinical practice to be able to measure things. And so if the patient can self-report that they're going from like a four for pleasure of eating, like it is super severely impacted, down to a one, giant quality of life improvement. Boom. And you put a number on it and insurance loves numbers.

Speaker1:
[13:50] I love that too because I feel like sometimes when I'm doing like meal evaluations and are just doing check-ins to make sure people are using their strategies and those kind of things, like it gets difficult to count how many swallows someone had for each bite or how many times or what ended up causing the cough on what texture. So having the patient have some insight or have some ability to report on some of those things makes our job a little bit easier.

Speaker0:
[14:20] Yeah, definitely.

Speaker1:
[14:21] I like an easy job.

Speaker0:
[14:22] I love an easy job. Love it. I am going to go back and read out loud the EAT-10 measures because we've kind of jumped around on them as they came up in the research. But I think we paint a really interesting picture. So one, my swallow problem has caused me to lose weight. Two, my swallowing problem interferes with my ability to go out for meals. Three, swallowing liquids takes extra effort. Four, swallowing solids takes extra effort. Five, swallowing pills takes extra effort. Six, swallowing is painful. Seven, the pleasure of eating is affected by my swallowing. Eight, when I swallow food sticks in my throat. Nine, I cough when I eat. Ten, swallowing is stressful.

Speaker0:
[15:04] If you imagine rating yourself above a two or above for all of these or even just half of them i would not want to eat which would definitely make me rank highly on number one losing weight right it's like we become avoidant with painful stressful situations we all know that we all know what we avoid whether it's the gym maybe your emma's i don't know you tell me but when it's not a comfortable experience, we try to do it the least we can. And the idea that somebody is potentially actively avoiding a basic biological need is really sad and I think goes back to the essence of dysphagia work, which is maintaining systemic health. You've got to be getting galleries down to help recover from wounds, to make sure you are feeling energized during the day, to make sure that your cells have the ability to like continue their everyday processes. I don't know if you guys know this, but eating is like important.

Speaker1:
[16:08] It's like right there with breathing.

Speaker0:
[16:10] It's right up there with breathing and like heart beating and all those other things that just like keep us going.

Speaker0:
[16:18] Which is wild when like, you know, to the point of the reliable historian, the adult failure to thrive is like a whole other aspect of this. You come in and people are like, I just don't care anymore. Like, have you been losing weight? And they're like, I don't know. I'm just like, well, would it bother you if you did? No. And it's like, oh, wow, like you're shutting down. Like you haven't been eating. You're found down on the floor, brought in by ambulance. And like, those patients we had this one guy who was like a classic adult failure to thrive, he came in and nothing nothing brought him any reaction let's have some food i don't care does that hurt i don't care and it was just like it was really hard and now we got that dude to eat sleep and do a minimal amount of exercise and you know what he got so complaining, i was like wow rehab really brought out the fact that you do not like things, And you went from being like, I was like, okay, how are you doing with your meals? I was like, I don't care too. This is terrible. There's no seasoning. Blah, blah, blah, blah. I'm like, wow, calories really made you an unpleasant person to work with.

Speaker1:
[17:32] Where's that diet?

Speaker0:
[17:36] Yeah, man. So we see that present in a lot of different ways.

Speaker1:
[17:39] I like this too, because this can go back to if someone's an accurate reporter, but maybe they don't have like the same insight as inside as us right like they're they don't like going out because they can't pick and choose the meals that are safe for them right like maybe they naturally are making super unsafe choices they're going for a super spicy pizza with ground sausage and all the sticky things when they need a UES structure yeah and we just have to be like this like it gets some education on like the differences in diet texture and how it moves. So like, like even that's, that can be helpful. So yeah, our brains are beautiful.

Speaker0:
[18:22] You know, food is such like an integral part of our lives. When I think about like a lot of times I just eat functionally, I'm like, got to get calories down during lunch, got to keep moving. But then when I sit down to dinner with my family, I really do revel in enjoying it. And the idea that that entire experience gets taken away by feeling like you can't go out to eat or you don't enjoy eating or you can't eat food that you like. I mean, really, again, quality of life, man, it really impacts you.

Speaker1:
[18:48] You could even bring like your family in on that too. Like if it was like you can't eat something at the table, but like bringing something you can eat to

Speaker1:
[18:56] the table and sharing that with your friends and family, like that would be good.

Speaker0:
[19:01] Yeah, man. The dysphagia cookbooks gotta gotta start selling those.

Speaker1:
[19:06] So for you we have made a badge buddy so this badge buddy includes both the e10 and section k because e10 wasn't very big and the section k is important we

Speaker0:
[19:20] Had more room.

Speaker1:
[19:20] We had enough room the section k is important when you're doing general screens too for your paperwork. For me, it's point-click care in your MDS reporting. Even if you're going through your quarterlies or you're helping screen new or existing patients, it's quick because this can help you quickly record someone's responses and either make appropriate referrals, get them to a GI or ENT, or get them on your caseload.

Speaker0:
[19:55] Yeah, I will say I don't have to do Section K anymore on PCC. But similarly, it's a great summarizing tool. For those of you who are unfamiliar with it, it's like A, loss of liquids or solids, B, holding food in your mouth, C, coughing or choking, D, complaint of difficulty or pain swallowing, E, none of the above. I think it's just a great way to very saliently communicate. Like, here's this person's top one to three issues. Hopefully they don't like the E10. Hopefully they aren't impaired across all of them because that would suck. So again, we're always trying to make you guys stuff that really highlights

Speaker0:
[20:36] quick ways to communicate or record information.

Speaker1:
[20:40] So give your badge buddy a try. Let us know in comments, emails if you think it's helpful or not. or if we need to redo it somehow.

Speaker0:
[20:49] Yes, we love doing more arts and crafts projects and moving things around on Canva. All right. It was great having the opportunity to chat with you, Emily. And hopefully it was helpful for you guys to hear a little bit about the Eat 10 and self-reporting validity because that's how we like to spend our Sundays.

Speaker1:
[21:08] Thanks for talking with us.

Speaker0:
[21:10] Bye.

Speaker1:
[21:12] You've been listening to Speech Talk.

Speaker0:
[21:14] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker1:
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Speaker0:
[21:32] If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, send us an email at hello at speech talk pod.com.

Speaker1:
[21:45] If you want even more speech talk content, check out our website at speech talk pod.com where you can find all of our resources we made for you copies of articles covered and Eva's blog following these topics and more.

Speaker0:
[21:58] We're your hosts Eva Johnson and Emily Brady.

Speaker1:
[22:01] Our editor and engineer is Andrew Sims.

Speaker0:
[22:04] Our music is by Omar Ben Zvi.

Speaker1:
[22:06] Our executive producers are Erin Corney, Rob Goldman, and Shanti Brooke.

Speaker0:
[22:10] To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers.

Speaker1:
[22:22] Speech Talk is a proud member of the Human Content Podcast Network.