June 2008 Newsletter

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