May 2007 Newsletter



                 Consultants in Dysphagia Evaluation and Management
                              817-514-MBS1 or 1-888-514-MBS1
                                           Clinical Café Newsletter
                             By: Ronda Polansky M.S. CCC-SLP
                                      Better Speech and Hearing Month
                                                           May 2007
                      In loving memory of a beloved mother and wife, Irita Simons Lambert
                                            Happy Mothers Day!
                                 Happy Armed Forces and Memorial Day!
                  Remember our men and woman that have sacrificed  to fight and maintain our freedom!

Deciphering Dysphagia with E-Stim 2007 – Hurst Texas – May 19, 2007.  New information for 2007 on oral and a new advanced neuroorthosis device for enhanced E-Stim treatment. Those who have attended before can attend and receive CEU’s with this updated course. You will get a great review of NMES, protocol, as well as receive new information on the current research, new videos, oral involvement, and receive the new adaptive device for E-Stim and get full credit for the course!    Registration information was sent in the April newsletter.  Call DiagnosTEX for more information.  Limited seating!  Do not delay!

Happy National Nursing Home Week – May 13-19th
  DiagnosTEX Holiday –DiagnosTEX will observe Memorial Day on Monday, May 28th.  Please keep this in mind when scheduling your MBSS around that time.  Thank you.  We have veterans working for DiagnosTEX and we honor them as well as those who have and are currently sacrificing for our freedom!
 ASHA Standards and Position Statement for Documentation on MBSS DiagnosTEX takes documentation very seriously and we pride ourselves in the detail of our reports.  The following is the required interpretation and documentation of videofluoroscopy by ASHA

  1. ID anatomic and physiologic swallow disorder of oral prep, oral, pharyngeal, and cervical esophageal phases
  2. Determine and document impact of anatomic and physiologic swallow disorder (i.e. location and approximate percentage of residue, laryngeal penetration, presence, timing, and amount of aspiration)
  3. Observe and document sensory awareness of residue, penetration and/or aspiration (i.e. cough, throat clear, secondary swallow).
  4. Document effectiveness of compensatory strategies, postures, maneuvers, sensory enhancement and bolus modifications.
  5. Document tolerance of and response to examination (i.e. following directions, fatigue, signs of stress, and ability to repeat therapeutic interventions).
  6. If applicable, describe any suspected anatomic (fistula, cricopharyngeal bar, diverticulum) and/or physiologic abnormalities of the esophagus and defer physician.
  7. Interpret finding in the context of patients overall medical, pulmonary, and neurodevelopmental, and nutritional status before making recommendations.
  8. Once determined: document recommendations regarding:
  1. Oral vs. non-oral delivery of nutrition
  2. Specific oral intake modifications (volume, viscosity, texture etc.)
  3. Therapeutic intervention required during meals (e.g. postures, maneuvers, sensory enhancement, assistance etc.)
  4. Safe feeding/aspirations precautions (e.g. sit upright, no straws, alternate liquids and solids, multiple swallows etc.)
  5. Positioning
  6. Need for thorough and consistent oral hygiene
  7. Dysphagia rehab treatment recommendations with exam findings
  8. Need for timing and re-eval.
  9. Diet consistent with ethnocultural preferences and practices
  10. Necessary referrals.
  • Provide Prognostic statement
  • Document that the results were discussed with appropriate medical personnel, individual with dysphagia, and/or caregiver
  • Ensure documentation is interpretive, clear, thorough, and legible.
  • We try to ensure that all of this information is provided to you in our reports.  We must document what was observed on the study in detail.  If the patient was observed to be safe on thin liquids and a chin tuck, or alternating mechanical soft with thickened liquids then that will be recommended and possibly an option if these strategies are unable to be followed through by the facility but the recommendation will be made and documented on paper as it is on the videotape and audio.  It is our responsibility to provide this information in a thorough MBSS.  You will not find a more detailed mobile MBSS report in DFW!

    DiagnosTEX protocol   There are controversies regarding MBSS protocol in our field. DiagnosTEX takes protocol very seriously considering the amount of MBSS we do in a month over a wide geographic area versus the average of 20-30 per month completed in a hospital setting.  Protocol is necessary for the safety of the patient, high percentage of interjudge reliability, problem solving, interpretation, formulating a diagnosis, and for training. The MBSS is designed to assess not only whether the patient is aspirating but also “why”, so appropriate and effective treatment can be initiated. SLP’s use both protocol driven and individualized approaches in order to accomplish this goal (Seibers & Linden, 1985). When a patient demonstrates abnormal findings, and SLP should deviate from a standard sequence to introduce modification of posture, consistency, and/or bolus volume in an effort to better understand the pathophysiology and develop a system for safe and efficient swallowing (Palmer et. al., 1993). Shortened lengths of hospital stays and diminishing coverage for SNF and OP, forces the SLP to be efficient in completing evaluations.  Given these constraints, it is important that we learn as much as possible from a single MBSS because it may be the only one they receive. (Campion & Haynes, 2006).  DiagnosTEX has the responsibility to complete studies that balance protocol driven but individualized approach based on how the patient proceeds and adapt and change to meet that patients needs when establishing the “why” in dysphagia.  This allows an experienced clinician to guide the study based on his/her knowledge and experience (Palmer et. al., 1993). 

    RESEARCH The Laryngeal & Speech Section of the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health is seeking patients with swallowing disorders to participate in cutting-edge research. Currently we are offering two studies for patients, aged 20-90 years, who have been diagnosed with dysphagia and are at risk of aspiration. Both of these studies require admission to the Clinical Center in Bethesda, MD. Study-related treatment and travel expenses will be paid for by the National Institutes of Health.  If you know of any patients who may be eligible for either of these studies, please provide the patient or his/her caregiver with a copy of the attached announcement.  
     1) 06-N-0212: A Comparison of an Implanted Neuroprosthesis with Sensory Training for Improving Airway Protection in Chronic Dysphagia.
     2) 06-N-0120: Induction of Volitional Swallowing in Chronic Dysphagia Post Stroke: A Novel Mechanism-Based Intervention.