Newsletter :: May 2005

Welcome Back Stonegate Facilities! We are SO excited to be working with you most of you again!! Thank you for all your determination and support! We appreciate all your consistent effort to make this happen over the past several months!

We still have our Starbucks cards available to you as always for having the patients up and ready!!

J J The highest form of flattery is imitation! J J

CMS tries legal avenue to fix Medicare Fee Schedule – ASHA Leader

CMS is seeking legal advice that would allow it to adjust the Medicare physician payment formula to head off six years of consecutive rate reduction! The announcement is the clearest sign to date that the agency wants to take up a proposal offered by ASHA, AMA, and other provider groups to head off looming cuts. CMS has already concluded that it can tweak the formula on an ongoing basis but that is insufficient to avert cuts in the short term. Mark McClellan, CNS Administrator acknowledged that the Bush administration was looking at a possible cut of 4% per year over the next 5 years. The cost of repelling the cuts through law is projected to be $140 billion over 10 years.

Changes in Taste Perception – ADVANCE by: Alyssa Banotai

There is a myth about taste decreasing as we age. The losses that do occur most commonly concern a loss of bitter taste. More significantly, age related olfactory losses usually affect all smells. These losses can begin as early as 40 and may result in a 70 percent loss by the age of 70. Cathy Pelletier, PhD, MS, CCC-SLP, an assistant professor in the Department of Communication Science and Disorders at Syracuse University in New York cautions that “there is a lot of thought that lemon products may improve swallowing, but we have no data to support that yet because these products are palatable with lower citric acid content. Only lemon that is unpalatable with highly citric acid level has been shown to make a difference in swallowing. Dr Pelletier uses the 9 point Hedonic scale in the food industry with her dysphagia population to yield valuable taste acceptance data. Sensory scientists believe the 3 cranial nerves that provide taste – glossopharyngeus, vagus, and facial nerve – inhibit one another. However, damage to one of the nerves will release another, allowing taste perception through the whole mouth. Dr. Pelletier points out that upgrading a diet may NOT improve intake. She cited works of Barbara Rolls. PhD of Penn state University who has documented decreased appetite and thirst throughout normal aging. Sensory satiety is a well- known phenomenon that the more we eat a food, the more we decrease our liking for it. SLP’s should test sensory science principles in dysphagia. It may not be all about texture and viscosity.

Dysphagia Tidbit – Swallowing Problems Associated with HD

Swallowing Problems are common among people with Huntington’s disease. Statistics have repeatedly shown that the number one cause of death among persons with HD is aspiration pneumonia. Swallowing problems often associated with HD is:

• Impulsivity or difficulty controlling amount of PO intake
• Difficulty controlling rate of PO intake
• Difficulty chewing or manipulating PO
• Delayed swallow reflex
• Oral delay, oral hold
• Difficulty initiating a swallow or inability to swallow
• Incomplete swallows, with food or liquid left in the mouth
• Lack or coordination between swallowing process, breathing, or speaking
• The need to swallow repeatedly for each bite/sip
• Chorea of the oral or pharyngeal muscles
• Drooling or anterior loss of PO