January 2016 Newsletter
DiagnosTEX
Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
JANUARY 2016
DiagnosTEX will be closed on January 1st – We wish everyone a blessed New Year! Look forward to working with you again in 2016!
2015 DiagnosTEX Dysphagia Calendars and clipboards are distributed! Thank you for all the great feedback! So much fun to see how much anticipation there is for them each year.
New Years Resolutions Statistics – Do you have one?
Type of Resolutions (Percent above 100% because of multiple resolutions) Data
Self-Improvement or education related resolutions = 47%
Weight related resolutions = 38%
Money related resolutions = 34%
Relationship related resolutions = 31%
Age Success Rates Data
Percent of people in their twenties who achieve their resolution each year = 39%
Percent of people over 50 who achieve their resolution each year = 14%
Length of Resolutions Data
Resolution maintained through first week = 75%
Past two weeks = 71%
Past one month = 64%
Past six months = 46%
Facility In-services! – December weeks were booked with Facility in-services! We will start scheduling the rest of January and into February after the holidays. Thank you ALL for having us out! We have so enjoyed seeing you and sharing this information with your staff.
BREAKING NEWS! Do not forget that we are now taking most HUMANA!
Upcoming CEU’s in 2016
Dysphagia Research Society 2016 Annual Meeting February 24-27 in Tucson, Arizona
TSHA IN FORT WORTH (woo hoo!) – March 10 – 12,
Don’t forget that Ampcare ASHA approved Certification ESP training is now on-line, go to www.swallowtherapy.com/online-ce-training-registration/
Success Story? Ampcare wants to know! Please tell Ampcare a little bit about your success stories with ESP®. Email info@ampcarellc.com. The one with the most submissions will receive a prize.
Necessity for mobile service – We are getting many inquiries from insurance companies regarding the necessity for mobile, therefore on our history/consult forms we have a section for you to check one or all that apply, please be sure to help us with this information in the case of an audit.
Necessity for Mobile Service:
___Transportation negatively impacts behavior/cognition/increases confusion
___Medically unstable, fatigue level concerns
___Physical condition/positioning compromised for transportation
Dysphagia Tidbit – Clinical Bedside Swallow Exam with Tracheostomy and Ventilator Dependent Patient– E Bicker 2014
Clinical experience has shown that evaluation and treatment of the tracheostomy and ventilator dependent requires a detailed awareness of the upper aerodigestive tract.This upper aerodigestive tract includes the SLP understanding the anatomy and structure of the pharynx, larynx, tracheal, and esophageal areas,. The swallow assessment in these patients spans beyond the assessment of oral feeding trials. The clinician must understand thoroughly how the integration of phonation function, respiratory status, and secretions management can impact deglutition function. The presence of the artificial airway provides an additional component to the dysphagia exam, involving potential tracheostomy tube size modification, one way speaking valve use, tracheostomy tube capping, cuff manipulation, and potentially ventilator modification.
TO DEFLATE OR INFLATE?
The tracheostomy tube cuff is inflated for mechanical ventilation and provides a closed, sealed, airway allowing patients to get full volumes for respiration and gas exchange. When assessing the functions of the larygopharynx, it is suggested that patients with cuffed tracheostomy tubes have the cuff deflated, at least partially, during swallow assessment. This will also allow for aspiration risk assessment below cuff level. It is recommended that medical orders for cuff deflation are required prior to deflation. For the ventilator dependent patient, it is preferred to have the presence of a respiratory therapist, to help transition from closed to open system by maintaining the vent settings (Bach JR et al 1990). This is needed since there will be leakage of air through the laryngeal and oral airways once upon cuff deflation (Manzano JL et al 1993).
This clinician prefers to have the respiratory therapist managing the ventilator setting, while SLP delivers bolus trials and provides cervical auscultation of neck in area of larynx and palpable assessment of the areas of the mandible, hyoid bone, and thyroid cartilage. It is an easier assessment when there are more hands to assist. Ideally, the decision to feed a tracheostomy/ventilator dependent patient by mouth should have the joint input from the respiratory therapist, pulmonologist, and SLP.