August 2009 Newsletter

August 2009 Clinical Café Newsletter By: Ronda Polansky M.S. CCC-SLP Monthly Motivator: STAY COOL! AUGUST

CONFERENCE – Got Ethics? – DiagnosTEX will host an ethics course at the end of August, in honor of the upcoming Labor Day!  “Ethics.Com, are you online?” will be scheduled for Saturday August 29th. Not only will this course meet your 2 hour ethics requirements, it will also give critical information regarding ethics in a clinical setting of dysphagia treatment. Registration is included in the newsletter. We started getting requests for registration in June! We did not start taking registration for this course until the newsletter was mailed out to give everyone fair opportunity to sign up… plus we were already registering for the July E-Stim conference. Seating will be limited and we have had MUCH interest in this upcoming course, so do not delay in registering to reserve your seat before registration is cut off at our max seating capacity. ESTIM conference in July – I just wanted to say thank you to all those who spent their Saturday with us during the E-Stim course! We had a nice size group of about 35-40 and you all were wonderful. Thank you for the encouraging comments and support of what we are doing! Thank you Rehab Pro for the great location and for lunch.

August Dates to Remember – BACK TO SCHOOL! 4th – National Night Out www.natw.org 22nd – Be an Angel Day – A day to do “one small act of service for someone” www.earthangel4peace.com Alzheimer’s Memory Walk (August –November) www.alz.org

Waiting on Family Members – We encourage family members to be present for the MBSS if they desire to be there. Being mobile allows the convenience of us “coming to the patient.” Mobile service does not work well for scheduling specific requested times and days. This is more appropriate for a non-mobile facility (such as a hospital) that runs schedules with appointment books and waiting rooms. Scheduling with a mobile clinic requires flexibility because of our travel to multiple locations across DFW. When informing a family regarding a scheduled MBSS time, we highly recommend that you also notify them that our schedule may vary slightly and request they show up 30 minutes before the scheduled time (being aware that ultimately arrival times can vary based on traffic, multiple patients, cancellations, etc.) Once we arrive, we cannot wait more than 10 minutes for family members to arrive. We can either complete the study without them or reschedule. However, if it is cancelled after we get there, the facility will be charged a travel fee for us showing up to do the study. If your family member is restricted by times and days, please advise them a non-mobile facility may accommodate their schedule better than a mobile clinic. Scheduling with mobile service is a prediction and best guess on ETA. We cannot predict traffic on that day, nor weather, cancellations, difficult patients, patients not up and ready when we arrive, complex and involved studies, conferences with present family members, patient vomiting, add-ons when we arrive at a facility, etc. There are many variables that take part in our day that may affect our schedule significantly. We do our best to keep to the schedule and will always call before we arrive. Please educate your staff and the family on the flexibility required in scheduling with a mobile clinic. Also, if a family member will be present for the study, it would be helpful to us if you put this information on the history form so we can take this into consideration during our day. Thank you! Students, CFYs, observers We were all “there” at one time! I teach one class every year at UTD on MBSS and absolutely love the students! We enjoy having students and CFYs come on the van and observe if they can! We love to share our knowledge and experience with them. We have many requests for scheduling an MBSS on specific days in order for students or CFYs to be present. Please understand that we cannot schedule around this, and if this request comes through, your MBSS may likely be delayed up to several days. We will only schedule based on geographical area (not to accommodate someone to observe). We would not be able to operate efficiently if we did that for every student request. We love having them on board with us, but cannot base our scheduled locations and times around them.

Upcoming Holiday – DiagnosTEX will be closed on Labor Day, Monday September 7, 2009. Please consider this when scheduling. Enjoy the holiday! Texas Summers – HOT! HOT! HOT! Shall I describe it any other way??? Unfortunately, this time of year is one we dread in the mobile business! Hot temperatures, being parked on hot concrete in the sun, running A/C on high, and/or sitting on one location for long periods of time, can often cause our generators to overheat. We take all precautions and maintain all required and preventative maintenance on our equipment, and strive to ensure this does not happen…but the Texas summer can be unforgiving and generators can only get so hot in triple digit temperatures. Please be aware that IF these generator issues occur we may have to adjust your scheduled time. Anytime we can park under any portico (covered entrance at the front of a building), would be helpful to us, your patients, and the completion of your studies. Please check with your administrators on this. Thank you for your understanding.

Physician House Calls – Introducing: Private House Calls LLC …Literally, the “Doctor at Your Door.” A typical house-call service is aimed squarely at serving the elderly and infirm in their homes. Though this company does not have to, nor wants to replace any of your current doctors, they do “finish the job” of attending to your medical needs as primary care specialists. Most of their patients are on Medicare and are retired, but not necessarily so. They have many patients who are disabled from physical or mental handicaps, but all of them benefit from having their medical needs completed and coordinated from their homes. Private House Calls, LLC combines traditional office-based medical care with home health services, bringing professional medical evaluations, competent physician and nurse practitioner medical care, laboratory testing, EKGs, x-ray tests and many other services to the patient in their home. This saves time otherwise spent traveling to and from the doctor’s office and the waiting in the lobby, while allowing for a much more comprehensive and relaxed evaluation in the comfort and convenience of the patient’s home. Medicare covers the cost of this service without restriction for all medically necessary services. In other words, their physicians may see you as often as needed to treat and stabilize your medical conditions, in as thorough a fashion as necessary to optimize your health! Why does Medicare promote this service, now? Because research has dramatically shown that patients receiving thorough house call services have FEWER hospitalizations, remain HEALTHIER throughout their lives, and COST Medicare much less to care for them. Why not increase your health span? Why not improve the quality of your life, your health and your vitality? Call them today at 817-882-9242 to schedule your first house call!

Dysphagia Tidbit – Research on E-stim with Submandibular Placement Deciphering Dysphagia with E-Stim (Campbell, Polansky, McAdoo, 1998) Subjects – 25 normal subjects Objective – to achieve laryngeal elevation with E-Stim placed on the submental region/submandibular area Method – Comparing laryngeal elevation with a dry swallow and then with E-Stim alone Outcome measures – recorded biomechanical movement on a graph utilizing a Computerized Laryngeal Analyzer during the swallow/ laryngeal movement Results – E-Stim elicited 76% of laryngeal movement as from a normal dry swallow E-Stim for dysphagia in head and neck cancer patients (Langmore et al., 2006) Subject – 7 adults, chronic dysphagia head and neck cancer patients, 2 years post radiation Objective – Evaluate effect of use of E-Stim on swallow function in dysphagia and evaluate whether swallow changes are accompanied by cortical reorganization Method – Subjects received E-Stim to submandibular area/submental musculature for 20 minutes a day followed by exercise for 10 minutes. Patents took the unit home and performed self treatment at home 3x per day, 6 days per week for 3 months. Outcome measures: Count of occurrence of penetration and aspiration on MBSS, self perception of quality of life, diet type Results – Aspiration was reduced from 50% to 14%;aspiration of liquids was reduced from 85% to 71%,residual were reduced from 90% to 70%; oral diet levels were improved across the board; PEG tube dependence was reduced from 58% to 42% NMES treatment Option for Dysphagia – (Polansky, Campbell, McAdoo, 2008) Subjects – 124 patients with dysphagia, in a LTC setting. The patients’ diagnoses included CVA, Parkinson’s disease, Alzheimer’s disease/Dementia, pharyngeal cancers and Pneumonia from a pharyngeal dysphagia Objective – To evaluate the effectiveness of E-Stim as a dysphagia treatment with electrodes being placed on the submandibular triangle/submental region to promote laryngeal elevation Method – Group 1 included patients receiving at least 20 therapy days of the NMES protocol as well as traditional therapy (78 patients). Group 2 included patients receiving traditional dysphagia therapy with no NMES modality (46 patients). Outcome measures – Improvement in diet level Results – In this study, 75% of the patients who received at least 20 days of the NMES protocol had a diet upgrade (58/78), while 25% of the patients did not (20/78). There have been more than 5,814 therapy visits using the protocol in this research, which would suggest that it is a safe adjunct.