Mr Sze, 76 years of age, came to this clinic three months after he was discharged from the hospital out of a stroke. He was put in tube feeding due to silent aspiration (food going to lungs without coughing), and had no sign of tube weaning ever since his discharge. Seeing his chance of weaning was diminishing with increased time of tube feeding, an urgent swallowing program was conducted.

When Mr Sze attended the first session, he appeared weak and lack of energy. The therapist decided that Mr Sze should pick up some muscle strength build up exercises before any swallowing training, out of the understanding of NSP theory. He was given some body and swallowing muscle exercises, which were modified to suit his elderly home environment.

He came back one week later for the second session, and was found to have improved strength. He was then trained with strength boosting exercises, which were paired with initial swallowing training. His first swallow attempt ended with choking which scared him from further trial. He was explained that “choking cough” was a good response as that protected him from food going into his lungs. Furthermore, that was the exact reason why he was put in tube feeding. Coughing was a tremendous improvement in his case. Gaining back confidence, he continued the practice.

The third time he came, he was able to feed on fluid without choking. He told the therapist confidently that he could swallow food. The therapist wondered why he was so sure of that. He said “I could feel it” . Right, this clever elderly voiced out the essence of swallowing, which was a solid feeling of that, “you know when you can do it”.

Few more sessions later, Mr Sze was seen for the last time. He could swallow food of different texture and had his tube weaned. He was so delighted to tell the therapist, “I could enjoy my favorite toast and drank my cold coffee”.

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