April 2016 DiagnosTEX Newsletter
Clinical Café Newsletter
April 2015
Happy Spring& Happy Easter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator:
April hath put a spirit of youth in everything.—William Shakespeare
It was so great to see everyone at TSHA! It was busy 3 days!
Thank you for stopping by the booth and seeing us! The Stress relief vans were a big hit! We had a great turn out on Saturday morning for the course, about 80 in attendance, thank you for staying until the last day, it was fun!
MAY is Better Speech and Hearing Month – Be prepared! This is next month! This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA has many resources to help you celebrate BHSM every day. www.asha.org . Some good educational material to share can also be found in the booklet ABOVE and BEYOND.
ABOVE and BEYOND By: Ronda Polansky M.S. CCC-SLP – Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation. Over 30 handouts on specific disorders in dysphagia in ONE location to use in your practice, plus a resource section for SLP’s on cranial nerve testing, pharyngeal exercises, and treatment techniques. A need to have booklet in your therapy bag!! Cost: $40.00. (plus S&H). Call us and we will get one out to you!
DVD – What you Can Not See At Bedside– Copies of MBSS studies for education of staff and families on various disorders and clear episodes of penetrations and aspirations. Cost – $40.00 (plus S & H). Great educational tool for anyone! This is the same videos we presented at TSHA
APRIL CEU Opportunities:
Ampcare ESP training in Texas – go to www.ampcarellc.com for more information and to register
San Antonio on April 1, 2016
Austin on April 6, 2016
DiagnosTEX is planning on another 2016 Summer course towards end of the summer, we will keep you updated!
DiagnosTEX QA Results Summarized – 406 patients evaluated in a month
Diets Recommended: Regular 123, Soft Reg = 11, Mechanical Soft – 80, Puree = 78
Liquid Recommended: Thin = 182, Nectar = 54, Honey 45, pudding -= 9
NPO Recommended: 93
Patient with aspiration: 36% (147) Percentage of patients who were silent aspirators = 86% (127)
Strategy usage: 38% used and determined effective to ensure safe and efficient PO
Percentage of cases identified with esophageal issues: 35%
Discharge rate after dysphagia therapy: 67%
AMA Diets: 17% (Medicare now considers repeat MBSS “not medically necessary” if a patient has previously signed an AMA/waiver on a previous MBSS recommendations).
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New Age in Healthcare, but ethical standards, confidentiality and the highest level of professionalism in healthcare should not change with HCP
Many social media tools are available for health care professionals (HCPs), including social networking platforms, blogs, microblogs, wikis, media-sharing sites, and virtual reality and gaming environments. These tools can be used to improve or enhance professional networking and education, organizational promotion, patient care, patient education, and public health programs. However, they also present potential risks to patients and HCPs regarding the distribution of poor-quality information, damage to professional image, breaches of patient privacy, violation of personal–professional boundaries, and licensing or legal issues. Many health care institutions and professional organizations have issued guidelines to prevent these risks. When used wisely and prudently, social media sites and platforms offer the potential to promote individual and public health, as well as professional development and advancement. However, when used carelessly, the dangers these technologies pose to HCPs are formidable. Guidelines issued by health care organizations and professional societies provide sound and useful principles that HCPs should follow to avoid pitfalls. Social Media and Health Care Professionals: Benefits, Risks, and Best Practices C. Lee Ventola
Dysphagia Tidbit
There are 2 types of Laryngectomies: 1) Supraglottic laryngectomy and 2) total laryngectomy
During a supraglottic laryngectomy (sooprah-GLOT-tik lair-un-JECT-uh-me), a surgeon removes the top part of your voice box (larynx), near your vocal cords. Your voice box (larynx) has two bands of muscle that form the vocal cords. The front of the voice box is made of cartilage and is sometimes called the Adam’s apple. Supraglottic laryngectomy can interfere with laryngeal elevation and sometimes vocal fold adduction. If a “laryngeal suspension procedure” is performed during reconstruction, laryngeal elevation is improved and swallowing is safely enhanced. If a supraglottic laryngectomy procedure encompasses more than the traditional procedure and includes portions of the hyoid bone, base of tongue, aryepiglottic folds, or false vocal folds, prognosis for swallowing recovery is more diminished.
A total laryngectomy requires separation of the airway from the esophagus. The trachea typically is brought forward below the level of the larynx and is sutured to the base of the neck just above the sternal notch, creating a permanent tracheostoma for breathing. Dysphagia after total in all likelihood, is underreported. Patients undergoing total laryngectomy have few swallowing problems following surgery due to the permanent separation of the trachea and esophagus. However, occasionally the laryngectomee may have problems propelling the bolus through the oral cavity and pharynx as a result of the loss of hyoid bone, which is the anchor for the tongue. Increased pressure in the pharyngoesophagus following laryngectomy requires the tongue to move with greater force. Stricture at the anastomosis may cause narrowing and reduced bolus flow through the pharynx. Pseudoepiglottis, a postsurgical fold of tissue from the pharynx at the level of the base of tongue, may serve as a mechanical barrier to efficient bolus flow and trap food in its pocket.
It is important to understand that during the normal swallow, the vocal cords close, just after the initiation of an exhalation, trapping the air in nearly full lungs and providing what’s known as “subglottic pressurization” . The physics of swallowing, therefore, are altered quite a bit as laryngectomees are no longer capable to maintaining this pressure. Before the laryngectomy, with every swallow, there was a typical degree of pressurization that assisted in driving the food through the pharynx and into the esophagus.
Learn more by asking for our April Laryngectomy Education Handout, next time we see you.