Newsletter :: October 2005


Monthly Motivator

The Sky Is The Limit

It may take courage to embrace the possibilities of your own potential but once you have flown past the summit of your fears, nothing will seem impossible!


Action Needed to Halt Restart of Therapy Caps – ASHA is aggressively working with Congress and other therapy organizations to develop a viable alternative to the Medicare therapy caps. The two-year moratorium on the caps is set to expire at the end of 2005. Without congressional intervention, speech-language pathology and physical therapy will again share a $1,750 financial limitation on Medicare Part B outpatient services for each beneficiary as of January 1, 2006.
ASHA’s goal in any new payment alternative is to:

  • Recognize speech-language pathologists as suppliers under the Medicare program, thus allowing them to bill from a private practice;
  • Allow for proper assessment and treatment of Medicare beneficiaries with complex needs in settings such as skilled nursing facilities; and
  • Maintain speech-language pathology services as a separate Medicare benefit.

Please contact your Members of Congress immediately through ASHA’s Take Action Web site at and request that they support legislation that would:

  • recognize speech-language pathologists as suppliers of Medicare services by separating SLP’s and PT’s in the outpatient Medicare statute (S. 657); and
  • repeal the therapy caps (H.R. 916 and S. 438).

For further information, please contact Stefanie Reeves, ASHA’s Director of Political Advocacy, via e-mail at

DVD for newly diagnosed PD patients “Managing Parkinson’s — Straight Talk and Honest Hope” is a new DVD produced by Mike Shanahan, who was diagnosed with the disease in 1993. The DVD features former Surgeon General C. Everett Koop, 10 medical experts and several patients. The featured doctors describe the symptoms, explain treatment options and give tips on how

newly diagnosed patients can live better with PD. Learn more about “Managing Parkinson’s — Straight Talk and Honest Hope.”

NEW DiagnosTEX SLP give-away! – Setting Goals and Treatment Objectives! – Ask for yours next time we see you!

FYI –Do you know what is commonly used for a PEG patient with diarrhea? Yogurt. The bacteria in yogurt will help stabilize the digestive system and reduce the diarrhea

Magic Cups – A new Hormel Healthlabs product. A versatile supplement serve frozen for an ice cream-like consistency, once thawed will not be thinner than a pudding consistency for a pudding dessert. Comes in four flavors of vanilla, chocolate, orange and wild berry. Some SLP’s are using it, I will keep you informed on the response. 1-800-633-3438 or

Hurricane Katrina We know many of you will be treating some of the people displaced by this tragedy. We are proud to say that some of our DiagnosTEX physicians have donated their time in treating these patients as they were evacuated to Dallas/Fort Worth. We expect some of you will need baselines on their swallowing to initiate treatment because you will have limited history. We realize there will be situations where paperwork is limited on payor sources. If you can provided us with as much demographics (name, address, DOB etc.) as possible when scheduling that will be helpful! Give us a call and let’s provide the best care and diagnosis for those affected by this disaster.

Cervical Ausculation Cervical Auscultation – is a general term that describes several techniques for listening to the patient’s breath sounds. In research, a laryngeal microphone is used. In clinical setting, a stethoscope is placed against the lateral side of the neck in the region of the larynx and placement is adjusted until cervical breath sounds can be heard. Cervical breath sounds are generally hollow or tubular in nature as compared with breath sounds heard over the lungs. Some clinicians now routinely use cervical auscultation although great caution must be taken. Generally the pharyngeal phase is considered normal if the pharyngeal swallow occurs promptly after oral transit and the patient holds their breath during the swallow and exhales directly after the swallow. Clear breath sounds also need to be heard after the swallow. Impairment in pharyngeal swallow can be suspected if there is:

Any deviation form the sequence of events

A flushing sound of material (usually liquids) heard prior to the initiation of the swallow

Any distortion of the voice after the swallow.

Studies done with this technique have found as little as 42% comparison of this identified by cervical auscultation as aspirating and those confirmed as aspirating on an MBSS. The highest percentage of correlation was 75%. This still means 25% of aspirators were missed by cervical Auscultation. (Swigert, 1998). This is a highly technical skill and many clinicians are using it without training. Many clinicians do not use the same terms to describe what they are hearing.

Dysphagia Tidbit – Cardiac surgery and dysphagia –Marionjoy Hospital in Wheatin, IL is the first hospital to report a high incidence of dysphagia following acute cardiac surgery in patients transferred from acute care to rehab. They have reported more than 27% presenting with dysphagia. Noel Rao, MD, said it seems high, but we are looking for it. There are several potential causes for this. A stretch injury of the recurrent laryngeal nerve can occur during surgery when the nerve, which loops around the heart is retracted. A post-op stroke or prolonged endotracheal intubation also may cause swallowing problems. Because of the multiple medical problems, patients can have neuromuscular weakness and therefore, a weak swallow. Marionjoy hospital showed 25% demonstrated aspiration and half of these were silent aspirators, and three-fourths have laryngeal penetration and pharyngeal residue. One of the main swallowing disorders was a delay in the swallow response. Tongue base retraction, reduced laryngeal elevation and closure were also a problem. Of the 27% who presented with dysphagia 16 experienced respiratory arrest, 12 developed post-op pneumonia and 7 had post-op fevers. MBSS was used to help determine treatment protocol. Within 2 months nearly 89% of the rehab patients were able to return to oral feeding for 3 meals a day. Nine came to the hospital already NPO.

It is all about over coming a impairment by using getting the correct diagnosis, using appropriate and safe techniques and educating the patient, family, and staff, so they can avoid pneumonia and aspiration.

ADVANCE August 2005. Susan Brady and Noel Rao M.D.