April 2007 Newsletter


Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
 April 2007
Happy Easter! Happy Spring!
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP

Clinical Café NewsletterMonth Motivator – Essence of Reflection
A strong character, founded on the living rock of principle, is an incredible gift.  It is designed to leave not merely an immediate impression, but to create a continuous, progressive, and never-ending legacy for the future.  It survives the person who developed it.

Deciphering Dysphagia with E-Stim 2007 – Hurst Texas – May 19, 2007.
New information for 2007 on oral and a new advanced neuroorthosis device for enhanced E-Stim treatment. So those who have attended before can come and have a great review of NMES, protocol, as well as receive new information on the current research, new videos, oral involvement, and the new adaptive device and get full credit for the course!
Registration information enclosed.  Limited seating, get your money and registration in early to save your seat!

We had great feedback on the Trach 101 conference in March.  Thank you to all who attended!

*******Note from our Billing Department – MBSS charges********
There will be a charge to the patient for an MBSS if they have not met their deductible for the year or if they do not have secondary insurance coverage that pays 100% of the co-insurance after Medicare.  Patients with private insurance will have a percentage payment depending on the amount paid by the insurance, (i.e. 50% or 60%, paid by the carrier, leaving 50% or 40% to be paid by the insured.)  A lot of families are stating they were told there was no charge for this study.  Please direct the patients or families to us with any questions regarding this prior to the study being completed.  Thank you!

DiagnosTEX website – www.dysphagiadiagnostex.com – CHECK IT OUT!
The website is being added to on a regular basis.  Now you can contact us by email on the website New to the website  is normal and abnormal swallow video for your view.  Keep up with our conference schedule on the website as well.  Do not forget our resource center in the Clinical Café to view all of the newsletters archives as well as all the SLP handouts.  Just type your topic in the search area, i.e. tracheostomy, and it will locate the handouts and newsletters with this topic in it! 

Starbucks cards
We started a program for the SLP’s a few years back, as most of you already know……..  If the patient is up and waiting at the front door with vitals and the medical chart when we arrive, the SLP will receive a  Starbucks gift certificate.  Having the patient ready helps our team stay on schedule and we appreciate this more than you know as well as the people we service!  Having to wait for the patient to get out of bed, get vitals taken, and locate that chart can put us 15-20 minutes behind and if that happens at 4 facilities, then we will be running an hour behind as the day goes on.  We can not wait longer than 15 minutes for a patient to get up as we have a schedule to keep at numerous facilities in a day. This program was designed for the facility SLP’s and not intended for various facility staff getting the patient up.  If the patient was being transported to the hospital, they would also have to be up and prepared to go.  We are not able to hand out multiple cards per facility, and our staff has been instructed to adhere to this policy. We appreciate all the SLP’s who do their part to motivate their staff to get the patient up, what you choose to do with your Starbucks cards completely up to you if you feel one of your facility staff deserves it. Thank you for having those patients up and ready for us. You deserve your java on us!

NEW SLP HANDOUT – CLINCIAL EXAMINATION – Identifiable Risk Indicators for Dysphagia. Get yours next time we see you! 

Did you know what Webster says?
Dysgeusia – refers to a disordered sense of taste, not smell
Hypogeusia – refers to reduced sense of taste, not smell
Presbyphagia – age related changes in swallowing as demonstrated by healthy older individuals
 Dysphagia Tidbit – Medically Fragile Adults and Malnutrition
Many studies have confirmed a high rate of malnutrition in SNF”s.  Malnutrition associated with dysphagia may cause muscle breakdown, depression, fatigue, and depletion of stored proteins ( Sonies et al, 2006).  Elderly individuals may eat but their caloric intake may not meet nutritional needs and micronutrients may be reduced causing under nutrition (Greipet et al,  Toth et al. Raynaud et al.) Unmanaged dysphagia can lead to dehydration and malnutrition and the associated malnutrition leads to lethargy and decreased ability to carry out personal hygiene, work, socialize, and walk.
Swallowing muscles are mainly striated, suggesting their metabolic rate during malnutrition may more closely resemble that of skeletal muscles than internal organs ( Sonies et al, 2006)

Clinical signs of Malnutrition
System                                     Signs                           Deficiency                   
Mouth                                       Bleeding gums             Vitamin C, Riboflavin
                                                Glossitis                       Niacin, Riboflabvin
                                                Atrophic papillae           Iron
                                                Hypogeusia                  Zinc, A
Neck                                        Thyroid enlargement      Iodine
                                                Parotid enlargement      Protien