August 2013 Newsletter
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Your work is to discover your skill and then with all your heart to give yourself to it. That’s the mark of a true professional.
Upcoming Holiday – DiagnosTEX will be closed on Labor Day, Monday September 2, 2013. Please keep this in consideration this when scheduling your studies. We will operate Tuesday – Friday that week.
Interesting fact: The first observance of Labor Day is believed to have been a parade of 10,000 workers on Sept. 5, 1882, in New York City, organized by Peter J. McGuire, a Carpenters and Joiners Union secretary. By 1893, more than half the states were observing “Labor Day” on one day or another, and Congress passed a bill to establish a federal holiday in 1894. President Grover Cleveland signed the bill soon afterward, designating the first Monday in September as Labor Day.
What are we celebrating? 155.2 million people 16 and older in the nation’s labor force in June 2012. Source: U.S. Bureau of Labor Statistics
New Nutrition Product – from NUTRA/Balance Products! Juice + Fibre product.
• The easy way to get fiber into the daily diet
• 10 grams of dietary soluble fiber
• A prebiotic
• 5 all natural flavors: apple, orange, fruit punch, grape, and low cal strawberry (only 30 calories)
• New product: Fiber Water + B12 Vitamin
• It is good for all ages
• No mixing required!
Check out our web page or call us for other nutrition products at www.nutra-balance-products.com
Texas Summers – HOT! HOT! HOT! 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/Cs on high, and/or sitting in one location for long periods of time can often cause our generators to overheat. We take numerous precautions, provide extensive preventative maintenance on our equipment, and strive to ensure this does not happen… but the Texas summer can be unforgiving! Generators can only get “so hot” in triple digit temperatures before yielding to the heat. Please be aware that IF these generator issues occur, we may have to adjust your scheduled time. It would be helpful (to us, your patients, and the completion of your studies) if we can park under a portico or in a shaded area. Please check with your administrators on this; we appreciate your understanding and flexibility during these hot summer months.
MORE INFORMATION on E- Stim conferences, products etc. b- You can find more information on ESP, order forms and information about upcoming conferences at www.ampcarellc.com . Check out the website and/or call AMPCARE directly at 682-561-2444.
ABOVE and BEYOND
Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation.
By: Ronda Polansky M.S. CCC-SLP
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. Summer Discount $30.00 (plus S&H). Call us and we will get one out to you! Thank you to all who have ordered already and have also referred others SLP’s to it.
Let’s talk therapy – The Effortful Swallow
Sometimes the best therapy for swallowing is swallowing itself. How you actually do that, can make all the difference in the dysphagia treatment. The exercise is just as the name implies, you swallow with effort, which means swallow hard! The therapy technique is attributed to Jeri Logeman (1989). The goal is to recruit more motor units, increase demand and create a muscle training/strengthening effect. This technique is used to help protect the airway when there is muscle weakness due to various conditions, such as head and neck CA, stroke, or generalized conditioning. The muscles of the tongue may not be doing their part to push, lift or squeeze to help propel food from the oral cavity into the pharyngeal space. The result of muscle weakness and reduced pharyngeal contraction is retention and residue orally and pharyngeally, which is at high risk of penetrating or aspirating after the swallow. When instructing your patients in this exercise, tell them to pretend to swallow a pill whole without water, or a grape. Those who have excessive secretions, may feel they cannot do this, so try to get them to swallow their own saliva/secretions. Remind them to do this throughout the day by placing post-it notes in all rooms, or wear a colored bracelet as a reminder. Sessions using the effortful swallow should be limited to 10 minutes of hard concentrated swallows. If the mouth gets dry, use a mister bottle. The effortful swallow can be used as an indirect or direct therapy technique, but for those who are NPO, this may be an exercise for them! This can also be coupled when using E-stim. Have them initiate an effortful swallow as soon as stim goes off.
Dysphagia Tidbit – ASPIRATION – James L. Coyle, Ph.D., CCC-SLP; BRS-S
What do they aspirate??? Liquids, solids???
Materials that are not soluble or that are not affected by the immune response are more likely to remain for a long time without being broken down. This would include things like the outer layers of vegetable items and similar things. The water in aspirated liquids can diffuse through the aquaporin protein channels in the alveoli (up to a point) but the other components of aspirated liquids will cause inflammation and possible remain. If you can imagine a raspberry smoothie (sorry for the analogy) that contains water, milk, and berries with little seeds, the water will diffuse through the alveolar membranes into the capillaries, some of the milk proteins will be broken down by inflammation, but the seeds will remain intact. The syndrome “diffuse aspiration bronchiolitis” is a distinct condition from aspiration pneumonia and is what patients with recurrent aspiration of solid matter, can end up with. It has characteristic pathologic and radiographic findings from aspiration pneumonia (see citation below). There are some studies that used autopsy results to describe this phenomenon and here is a link http://www.ncbi.nlm.nih.gov/pubmed/17460460.
Mukhopadhyay S, Katzenstein AL. (2007). Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens. Am J Surg Pathol. 31(5):752-9.