Newsletter :: July 2005

Three vans to service you!

DiagnosTEX now has 3 vans operating in the DFW and surrounding areas. We work very hard to maintain our 24-48 hour service. You will not find a better quality and more detailed study anywhere in DFW. We would like to welcome Tia Perilloux M.S. CCC-SLP, who has completed several months of DiagnosTEX training and we are excited to have her. She is a quick learner and very passionate about this service as we are. She is a great addition to our team and we think you will feel the same.

Quality Assurance –

DiagnosTEX is the only Mobile MBSS company that completes QA in 2 forms to ensure the highest quality service:

1. We follow up on every patient we service and a QA report is completed monthly
2. We also do internal QA on our SLP’s and the MBSS they have completed to make sure all recommendations and diagnosis are appropriate. The QA is reviewed by 2 or more SLP’s of over 10 years experience in doing Modified Barium Swallow Studies.

We would also like you to fill out the satisfaction survey included so we can improve our service to meet your needs. Thank you in advance for taking the time to fill this out and fax it back to us.

Dysphagia Tidbit – Cardio-pulmonary patients

What options do we have with our COPD, emphysema, and bronchitis patients? These are the patients with the compromised respiratory/cardiac status, poor endurance, oral intake, and can not coordinate respirations and swallowing. Most pulmonary patients have cardiac impairments due to the strain that breathing problems inflict upon the cardiac system. Pulmonary patients often have difficulty utilizing compensatory strategies and exercises due to endurance. Thickened liquids can sometimes be contraindicated as it can increase retention in the pharynx. An MBSS is important to have for a pulmonary patient with questionable dysphagia and a recommendation of thickened liquids at bedside.

Typically the COPD patients can be so hungry for air; they try to inhale before their already deconditioned swallow is fully complete. Due to poor pressure generation during the pharyngeal phase this is likely to result in increased retention and residue and this can enter the airway during period of inhalation or air gasps. Other issues to seriously consider is the reduced pharyngeal sensation which often results from extended use of steroids in pulmonary patients………………….the result………………SILENT aspiration. Patients with impaired respiratory support often have pulmonary edema, or fluid back-up in the alveoli, which prevents a full exhale. While each air filled sac opens upon inhale, it shuts closed before full exhalation can occur, thus trapping air and causing many patients with COPD to become barrel chested. These patients lose the ability to collapse their chests, and the muscles that support the rib cage loose their ability to stretch due to disuse. SLP can address muscle function in these respiratory patients. Treatment goals can include lengthening respiratory cycles, as well as chest wall excursion. SLP can use pursed lip breathing. During exhaling purse lip breathing prevents the alveoli from slamming shut, allowing the patient to completely exhale. Use a watch with a second hand to time inhalation and expiration separately. The exhalation should double in time (ex. From 2 sec to 4 sec). Two other maneuvers are putting a pillow on the patient’s diaphragm and providing firm yet gentle pushing during exhale and applying one’s hand to the sides of the patient’s rib cage and jiggling the muscles by shaking the hands up and down as the patients exhale. Put a measuring tape around the bottom of the rib cage at the xiphoid process and measure a full inhalation and full exhalation while the pt is seated. The difference between these 2 numbers is chest wall mobilization. The clinician should expect this number to grow larger with treatment. SLP can also develop strength with ROM exercises without resistance lingually and with facial and labial muscles. Usually when patients make gains in strength, their respiratory cycle elongates and their vitals are stable it is time to focus on isolated muscle responses and progress them to endurance training. Monitor O2 sats during exercises to help indicate level of intensity and duration. ADVANCE June 13, 2005, Vol 15, No 24