June 2008 Newsletter




Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
June 2008
Happy Father’s Day!
Do not forget to fly your American Flag on the 14th in honor of our country, our troops and our freedom!
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator: Attitude
There is never a crowd on the extra mile!

A sad goodbye! After many, many years of working together in this field we have to say goodbye to Charlotte Rice M.S. CCC-SLP, as she is moving out of Texas.  We will miss her terribly as we know all of you will as well.  She is a gifted clinician and has contributed greatly to the quality and training program here at DiagnosTEX since 2003.  We feel blessed to have had her as a part of our lives, as a friend and colleague, and we wish her the very best life has to offer her and her family in their new location.
Thank you Charlotte, for all you have done for DiagnosTEX and the facilities, SLP’s and patients that you helped service for all these years, you will be greatly missed by us all!

Summer DiagnosTEX CEU Conference – STRATEGIZE WITH STRATEGIES! Can you believe we are 6 months into 2008!  Where does the time go??? We have scheduled a summer CEU conference.  Registration form will be included in July newsletter. Hope to see you there!!

Upcoming DiagnosTEX holiday DiagnosTEX will proudly observe our Independence Day Friday July 4th as we celebrate our country’s Independence and honor our veterans and current military. Please keep this in mind when scheduling your MBSS that week.

Dates to remember in June
June 1 – Cancer Survivors day – www.cancer.org
June 9-15th – National Men’s Health week – www.menshealth.com
June 12-19th – Nursing Assistants Day and week – www.cna-network.org
June 22-28th – Helen Keller Deaf-Blind Awareness week – www.helenkeller.org

TACKLING MRSA THREATS:   Methicillin Resistant Staphylococcus Aures of the sputum.
The health care standard locally for MRSA is 3 negatives lab results to remove a patient out of isolation or contact isolation for current positive cultures.  Exceptions can be made if the patient’s MRSA is colonized, being treated currently with antibiotic longer than 24 hours, if the patient can tolerate masking, and can be scheduled as the last study for the day on the mobile clinic.

Please realize to schedule an MBSS a patient at the end of the day may require special scheduling and may require several days to make this accommodation work. Cleanliness is the not-so-secret weapon that can go a long way in preventing the spread of MRSA in your facility. The CDC has identified specific factors that make conditions ideal for the transmission of MRSA. Whether in medical offices, hospitals, nursing homes, rehab facilities, schools, prisons/jails or elsewhere, these “Five C’s” can help MRSA thrive:

  1. Crowding
  2. Frequent Interpersonal Contact
  3. Compromised Skin
  4. Contaminated Surfaces
  5. Lack of Cleanliness

Learn more about prevention at www.alimed.com

SLP Handouts – We are handing out a new Nursing Notification sheet to assist with your scheduling times and retrieving vitals.  Hope this is helpful!  All laminated DiagnosTEX handouts and past newsletters can be found on the DiagnosTEX website at www.dysphagiadiagnostex.com in the Clinical Café.  

Scheduling – Just a reminder that if you request to schedule a patient with a specific time of day
(i.e. before 1pm, after 10am, AM only, no Fridays, after 2pm etc.) or a specific day (i.e. M or F only), scheduling  the MBSS may be delayed several days due to scheduling conflicts with other facilities or the specific areas we are servicing that particular day. Also if we are in the area the day you fax a study in, we may try to add your facility on if our schedules permits, if you decline we may not be able to reschedule your study until we are back out in the area again.  Many of you are so flexible and accommodate us when we add you on, and we appreciate you!! This allows us to be efficient in our scheduling/driving and to get to you as quickly as possible. Please notify your families, other staff and physicians that restricted times and days may delay the scheduling of the MBSS.  Periodically we have had HH patients/families as well as facilities drive their patients/residents to our office in Bedford for the first study of the day before the mobile clinics leaves the office or the last study of the day when the mobile clinics return, this is always an option for your patients if you would like to get the MBSS completed earlier than we can schedule it on our routes.

Dysphagia Tidbit – WHAT IS A CHIN TUCK? The Chin-down maneuver is a head and neck posterior in the anterior direction.  In biomechanics and functional anatomy, it is well known that flexion and extension movement of the cervical spine involve coordination motions in two anatomical areas: 1) occipito-atlanto-axial (C1-C2) and 2) lower cervical region (C2-C7). Therefore biomechanical or functional anatomical sense of term there are 2 kinds of flexion and their combination.  A review of past reports on the chin-down and chin-tuck maneuvers found that none of them presented a clear definition of the posture in terms of functional anatomy.  For dysphagia patients, even a slight morphologic difference or dynamic change in the bolus pathway could mean serious results such as aspiration. Logemann and Ekberg mainly use the term chin-down, while Groher, Ertkin, and Bulow mostly use the term Chin-tuck, with both groups not differentiating the two terms. Under videofluoroscopy, preliminary investigation showed that different positions had different effects on the oropharyngeal structure and even minute changes brought about different anatomical changes, implying different gravitational effects on the bolus pathway.  A survey of SLP’s in USA and Japan indicated that 42% USA SLP’s though the chin-down posture and the chin-tuck were one in the same, 58% thought they were different. Fifty percent of the Japan SLP thought they were the same and 23% thought they were different.  Twenty-seven percent did not know and/or were not sure what a chin tuck was.
Sumiko Okada, Eiichi Saitoh, Jeffery Palmer et. al. What Is the Chin-down Posture?  A Questionnaire Survey of Speech Pathologists in Japan and the United states, Dysphagia , April 10, 2007