After an early start to get to Belvedere Polling Station by 6.30am I was home by half nine to cook an apple crumble for Iona. I went with the children to vote soon after eleven, then went in to see Isobel at a quarter to twelve. Isobel had only had a pot of balanced supplement for breakfast. Isobel was fast asleep when I arrived.

Victoria, the Speech and Language Therapist arrived at noon and lunch materialised a couple of minutes later. I fed Isobel lunch while Victoria observed and sometimes felt Isobel's throat. She said she was very happy with how Isobel was being fed, including a number of minor aspects which I had either not understood or not thought important. She was especially keen about me talking to Isobel before each spoonful about what was on the spoon. She confirmed that Isobel's swallowing was very variable in strength - this was already suspected as audible and visible swallows occurred at intervals of five or ten minutes while she was eating. Other swallows are not easily detectable by me although Victoria could say when they took place (she said that 80% of her work as a community SLT was involved with swallowing and only 20% was conventional speech problems). As already known, Isobel is usually having to swallow a number of times to clear her mouth after taking a fairly small spoonful of food. Isobel ate all of the first course and we moved onto her custard dessert. She ate about half of this, getting gradually more tired. This was a good thing as one of the aims of having a lunchtime observation was to allow Victoria to see the fatigue effect and to judge how it could best be handled. She suggested that with the addition of high energy shots to some drinks, that these should be given a higher priority than dessert. Today we switched to the drink, leaving the second half of the dessert. Isobel finished the drink, getting slower and slower and taking a long time. By the time she had finished the drink she was very tired. She fell fast asleep with no possibility of finishing the dessert. These difficulties were expected at lunchtime, Isobel often misses lunch altogether and generally performs better at tea time. Apart from giving more priority to the energy enhanced drinks and pursuing the matter of the positioning collar Victoria did not think that anything could be improved. She did not arrange another date for a visit but will be in touch in a couple of weeks time. I did not stay long once Victoria had left, I went home at a quarter past two. The process of eating lunch took well over an hour and a half and left Isobel exhausted.

I came back in at five o'clock. Isobel had been fast asleep all afternoon. She ate the main course of her tea without difficulty although clearly very tired. She had a couple of spoonfuls of normal blackcurrant squash and then ate all of her yogurt dessert increasingly slowly. When she had finished her dessert she could only manage a couple of spoonfuls of drink before falling deeply asleep. This was not surprising after her efforts at lunchtime. I sat with her for a while but there was no sign of her waking. I came home at half seven.