Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
Happy St. Patrick’s Day
There is never a crowd on the extra mile
**Hurst Texas – Tracheostomy 101** – Hosted by DiagnosTEX
Saturday, March 3, 2007 – FULL HOUSE. SEE YOU THERE!
HOSPICE Patients – Please advice us of any patient under Hospice care and the name of the Hospice company and their contact information with your paperwork, prior to scheduling. We also need the hospice diagnosis listed on the history form. We have had several from various facilities that were filed with MC, only to be denied and then we send a lot of time trying to locate the Hospice company and contact information, after the study is completed, then it becomes difficult to negotiate a fee with them. Thank you for your help and consideration of this when you schedule a hospice patient.
History Form – A New history form is included in this newsletter, please update your paperwork for DiagnosTEX. Thank you!
Visit the DiagnosTEX Website! Check it out! – www.dysphagiadiagnosTEX.com On the DiagnosTEX website you can find out about us! Check on conferences, newsletters, required scheduling paperwork, email us, see MBSS videos, shop our bookstore, download our SLP handouts, and so much more to come!
New SLP staff –As most of you know Alisha and Tia have been pregnant the past “few” months. J Alisha gave birth to a beautiful baby girl on February 22. Tia is due this month and will be moving out of the DFW area after the baby is born. We want to thank Tia for her hard work, commitment, and service she provided at DiagnosTEX for the past several years. We will miss her as I know many of you will as well, but we wish her and her new family the very best! Alisha will return to DiagnosTEX after her maternity leave. We are excited to welcome Kelly Murray M.S. CCC-SLP and Rebecca Morrison M.S. CCC-SLP. They have both completed 3 months of structured training here at DiagnosTEX and will be a wonderful addition to our SLP staff. Both are exceptional Speech Pathologists with years of experience in the profession and we are excited they are here.
Oral Wounds – ADVANCE ONLINE EDITIONS FOR SLP 2/5/07
A study at the University of Illinois reveals that wounds in the mouth heal slower in women and older adults. Testosterone may help the wounds heal faster in men, regardless of age. It is a potent anti-inflammatory hormone that is abundant in saliva. Women are usually more prone to inflammatory diseases. In skin, a woman’s wounds heal faster than a man’s, but the more inflammation a person has inside their mouth, the slower wounds appeared to heal. In this study it became apparent that the healing process in skin and mouth tissues is different in some fundamental way not previously expected. This is significant research and important for implications in surgical procedures and practices.
Oropharyngeal Cancer – ADVANCE Vol. 17, No. 7, By: Desiree Voinche
A study completed at University of Texas in Houston, set out to determine the incidence of severe dysphagia in oropharyngeal cancer and evaluate difference in swallowing function based on treatment type.. The use of chemoradiation resulted in a trend toward more swallowing toxicity and PEG placement during and initially after therapy. However there appears to be no difference in long term feeding tube dependence and severe swallowing dysfunction between patients who received radiation alone compared to those receiving chemo. They stated that the detailed effects of treatment on swallowing cannot be assessed without a Modified Barium Swallow Study on every patient.
Dysphagia Tidbit – The Role of the Speech Pathologist in Laryngectomy Management:
Jane-Frances Gooden, Courtney Jones, Alyssa Mann, Marita McDowall and Jo Shugg. Supervised by Louise Brown.
School of Human Communication Sciences, La Trobe University, Melbourne, Australia.
Speech pathologists receive little exposure to laryngectomy during university training. In a survey by Melvin, Frank and Robinson (2001), many speech pathologists indicated they felt unprepared to work in the area of laryngectomy and required further training, clinical exposure and coursework to improve their skills in this area. It is suggested that speech pathologists dealing with a laryngectomy client should be appropriately trained, or should consult colleagues with more experience in this specialist area*. Duties of the speech pathologist in laryngectomy management have been described (American Speech-Language-Hearing Association, 2004; Doyle, 1994). These duties may include the following:
Jane-Frances Gooden, Courtney Jones, Alyssa Mann, Marita McDowall and Jo Shugg. Supervised by Louise Brown.School of Human Communication Sciences, La Trobe University, Melbourne, Australia.Speech pathologists receive little exposure to laryngectomy during university training. In a survey by Melvin, Frank and Robinson (2001), many speech pathologists indicated they felt unprepared to work in the area of laryngectomy and required further training, clinical exposure and coursework to improve their skills in this area. It is suggested that speech pathologists dealing with a laryngectomy client should be appropriately trained, or should consult colleagues with more experience in this specialist area*. Duties of the speech pathologist in laryngectomy management have been described (American Speech-Language-Hearing Association, 2004; Doyle, 1994). These duties may include the following:
- Education of the client regarding changes to expect post-laryngectomy in communication, and anatomy and physiology;
- Working within, and communicating with, a multidisciplinary team to ensure optimum and individualized care for the client;
- Presenting post-laryngectomy voice restoration options in an unbiased manner;
- Selecting appropriate candidates for receiving a tracheoesophageal puncture (TEP) and voice prosthesis;
- Determining an appropriate voice prosthesis for a client, and inserting the prosthesis;
- Teaching the client how to insert the prosthesis and produce voice;
- Teaching the client, their family or caregiverrs how to clean and care for the external stoma and TEP site;
- Helping the client trial different voice prostheses, and problem solve to achieve optimum effectiveness.
In the management of clients who have undergone total laryngectomy, a specialist Head and Neck clinician is usually involved in some way* (Perry, Shaw & Cotton, 2003). Due to the nature of total laryngectomy, dysphagia assessment and intervention is less of a main role of the speech pathologist than it is with other clients with palliative care needs*. However, total laryngectomy clients still have a risk of dysphagic complications, with dysphagia incidence in these clients ranging from 10-58% (Groher, 1997). Dysphagia following total laryngectomy may be due to surgery-related changes to the cricopharyngeal muscle (Groher, 1997); tumour recurrence; narrowing of the oesophagus; fistula formation; second primary tumour in the oesophagus; or an abscess (Balfe et al., 1982, as cited in Groher, 1997). Irradiation may also have a negative impact on upper oesophageal motility (Hanks et al., 1981, as cited in Groher, 1997). A client with a tracheoesophageal puncture (TEP) may experience swallowing complications, such as aspiration of food or fluid through the TEP or tracheoesophageal valve*; aspiration of the voice prosthesis; narrowing or blockage of the hypopharynx, external tracheostoma or oesophagus; and stoma infection (Groher, 1997). In such cases, the speech pathologist will be directly involved in problem solving to minimise aspiration risk and maintain the client’s safety and comfort during oral intake*. If oral intake becomes unsafe, percutaneous gastrostomy (PEG) feeding may help provide hydration and nutrition for clients during palliation (Bulman, 1998).