August 2016 Clinical Café Newsletter
Blue Skies, Hot Sun! Summer is still here!
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.
Be thankful for the opportunities given to you to make a difference in the world.
That’s the mark of a true professional.
DiagnosTEX New SLP’s – We would like to introduce our new SLP’s, Jeney Mammen and Kimberly Anderson. They come to us with years of great clinical experience and they are both going to be a fantastic addition to our team. You will enjoy working with them both, as they finish up their DTEX boot camp training J
No Holidays in August – We will be running Monday-Thursdays as normal.
Home health scheduling – Please notify your HH patient – DiagnosTEX will only attempt to schedule a HH visit 3x. We limit this attempt to 3, because to be eligible for home health the patient is supposed to be home bound. We understand that patients have doctors’ appts etc., but if they are regularly not at home during the day after 3 scheduling attempts they will be removed off the pending list. As with any facility based patient, when time and day restrictions are provided, this will frequently delay scheduling as we cannot meet specific days and times on a regular basis. If your HH patient would like to meet the van at one of our stops or meet at the office, this is always an option as well and we will try accommodate to the best of our ability.
New History/Consult form – Can be accessed from the website at www.dysphagiadiagnostex.com.
Alzheimer’s In-service – Creating Moments of Joy, By: Jolene Brackey – NO charge, suggested donation of $10.00
Go where the person is living in their minds, focus on abilities that they have not their losses. The greatest education is working with Alzheimer’s.
Wednesday August 10 in Southlake Texas – 12:45-4:30pm
Thursday August 11 in Hudson Oaks – 9:30-1pm.
For more information call 800-272-3900 or visit www.alz.org/northcentraltexas
DIAGNOSTEX Fall CEU course – In the planning stages…….Be looking for more information in the September newsletter!
Top 3 statements not recommended as reasons for MBSS:
- Family Request – Medicare does not see this as medically necessary and puts up a red flag in audits.
- Pt refusing to follow recommended diet – Then likely MBSS recommended diet will be refused too, and Medicare does not see this as medically necessary and will alter approval for future studies if they refuse multiple recommendations.
- Pt refusing PO intake – It they won’t eat the good stuff, they will not take barium either
New Venture for one of our SLPs – check it out and as a possible referral your patients once they D/C from you!
Neurologix Therapy, owner Kelly Murray M.S. CCC-SLP and Emily McMurtrey M.S. CCC-SLP
NeuroLogix began with a vision for building a need specific therapy clinic serving adolescents and adults. They focus on neuro-based limitations, such as difficulties with executive function or learning, concussion management, and other cognitive disabilities. Additionally, they treat speech and language deficits resulting from stroke or brain injury, including dysphagia. Thier therapists have extensive experience working with patients and clients in therapy clinics and medical settings, addressing neuro-based limitations such as speech, swallowing, language comprehension and verbal expression, attention, memory, reasoning and other higher level cognitive skills. Whether you have a medical diagnosis such as TBI, or CVA, or you have a learning disability such as ADD or dyslexia, or simply just have a desire to maximize your cognitive function, NeuroLogix therapists have the skills and experience to fit your needs. The goal of NeuroLogix is to continue to assist clients throughout the rehabilitative process as speech-language pathologists, but also to support otherwise healthy individuals reach their full academic or professional potential related to executive function skills as well as swallowing. For more information go to: www.neurologixtherapy.com .
Both Kelly and Emily are trained in Ampcare ESP!
Dysphagia Tidbit – Decreased epiglottic movement, is there treatment for this? – Before we can answer the question, we need to clarify some terms.. The epiglottis is a cartilage, not a muscle, and therefore does not have the power to move on its own. The term ‘dysmotility’ means inability to move spontaneously, or an impairment in the ability to move spontaneously. The word ‘mobile’ is nearly like motile, but has a broader definition: it refers to the ability to move or be moved (passively) from one place to another. Thus, if we use a term to refer to the epiglottis that is not moving, we need to talk about its dysmobility or immobility, not dysmotility. Unfortunately, this term is not the best one to describe the problem, either, because it places the blame on the epiglottis, when the problem may be with the ligaments and muscles attached to the epiglottis. During swallowing, the epiglottis is moved passively by the force of muscles that are attached to it -pulling the tip posteriorly so that it assumes a horizontal tilt and bending the tip down (the ‘downfolding’ motion). The primary attachments at the tip and sides of the epiglottis are to the hyoid bone while the base of the epiglottis, referred to as the petiolus, attaches to the thyroid cartilage ligament. As the hyoid and thyroid cartilage elevate during the swallow, they move the epiglottis to a horizontal and then inverted position, covering the arytenoids and vocal folds. The base of tongue then presses against the lingual surface of the epiglottis, helping to squeeze out the contents of the valleculae. Sometimes, the epiglottis is to blame for its immobility. In old age, the cartilage can become partly calcified, and then it is not as mobile as it was in its younger days. After radiation therapy, the epiglottis can be edematous or friable and not be as mobile as it used to be. Sometimes, the epiglottis is very mobile, and the muscles are strong, but a cervical osteophyte impinges into the pharyngeal airspace, making the passage much narrower. The epiglottis may have difficulty inverting completely in this constricted space. So mechanical or anatomical problems can impede the movement of the epiglottis and it is very important to consider these reasons when viewing incomplete epiglottal movement. In the majority of cases, however, the reason for the reduced epiglottic movement is inadequate hyolaryngeal elevation, with reduced traction and pulley forces exerted on the epiglottis. In answer to the question about what treatment should be prescribed for an ‘immobile epiglottis’, we must first determine the cause. If it is an anatomical change, the best treatment may be to find the head and neck position that allows fullest passage of the bolus during swallowing. If the cause is neurologic, then strengthening exercises may be the answer. Two exercises known to promote better hyolaryngeal elevation are Shaker’s exercise (1, 2) and the Mendelsohn maneuver (3). If the patient has a neurologic problem such as ALS, however, exercises are contraindicated and postural changes are the best strategy. An article on epiglottic dysfunction is one by Garon BR, Huang Z, Hommeyer S, et al., ”Epiglottic dysfunction: abnormal epiglottic movement patterns”. Dysphagia 17: 57-68, 2002. It has references to many other excellent studies. Susan E Langmore PhD, CCC-SLP, also see www.speechpathology.com, Treatment for Epiglottic Dysmotility by Susan Langmore, PhD, CCC-SLP