Positioning CASE STUDY – ENGAGE APOD
Parke View Rehabilitation and Care Center, Burley, ID
Trent Gunnell, MHA, MS CCC/SLP, DOR
Patient: 86 year old male
Primary Diagnosis: Lewy body Dementia, DM, Behavioral disturbance, hyperlipidemia, dysuria,
HTN, glaucoma, depressive disorder, dysphagia
Existing Wheelchair Seating: Highback reclining sling seat wheelchair with foam cushion
Positioning / clinical Issues: Pt was in sacral sitting and sliding with right lateral lean. Pt had poor
intake (less than 25% of meal) with poor oral control/management and risk of aspiration and
subsequent pneumonia. He was unprepared for the act of eating with poor bolus management
increasing risk of aspiration and weight loss. He presented with oral dysphagia and demonstrated
anterior loss which was exacerbated by poor positioning. His diet texture was downgraded to pureed
by nursing. He was on thin liquids however demonstrated poor intake and a 9% weight loss.
PostureWorks Intervention: Engage APOD Medium Profile
Outcome: Pt now demonstrates improved upright midline trunk positioning with no sacral
sitting/sliding or lateral leaning and a midline head position. He demonstrates increased attention and
anticipation with intake because he is in an improved position which decreases his overall risk of
aspiration with improved bolus management. His oral intake increased to 50% or more with each
meal and decreased anterior loss. His diet texture was upgraded to mechanical soft. He now
demonstrates improved ability to manage thin liquids as his head is in midline.
Quality Outcome Measures Impacted by Intervention: QOL*
Feedback from Therapist: “As part of our intervention, the change in positioning when the pt was
placed on the Engage APOD had an immediate impact on my pts ability to anticipate the act of eating
and improve his intake and subsequent safety during the swallow.”
*QOL Studies indicate that 54% of all SNF admissions are malnourished; the range of malnourished elderly in
SNFs range from 20-87%. In addition, 60% of all residents experience an initial weight loss following admission.
Dementia places pts at a higher risk for weight loss and dehydration. Current statistics estimate that 60-80% of all
residents in long-term care have a dementia diagnosis. Dysphagia and Nutrition Management In Patients With Dementia:
The Role of the SLP, S.Curfman, MA, CCC-SLP May 23, 2005
Note: This is a representative example; actual user evaluations, and decisions regarding the appropriateness of a
particular product for a particular individual, should always be made by a qualified healthcare professional.