October 2008 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
October 2008
Happy Fall!

Monthly Motivator: Recognition
The best minute you will ever spend is the one you invest in someone else!

FYI -Upcoming in October – I have been invited by SPAND to repeat the course Strategize with Strategies, Saturday October 11, 2008, from 8am-1pm. SPAND is the Speech Pathologists’ Association Near Dallas which was founded in September,1994. Membership is open to any individual who holds a bachelor’s degree or above in speech-language pathology. Membership dues are $35 per year and must be paid on or before the September meeting of each year. Non-members may attend for $10 for each meeting. The Saturday workshops are $12 for members and $25 for non-members. Students may attend the evening meetings for free and the Saturday workshops for $5. They are held in Richardson. You can check out the website at www.spandspeech.com .  If you are interested in attending, email them at cfiona21@yahoo.com to notify them that you are coming and then you can pay at the door. They will accept cash or check, no credit cards.

DiagnosTEX Policies and Procedures DiagnosTEX SLPs are qualified and extensively trained not only to complete a quality MBSS but also manage and handle many different patients and behavior.  There are times we will request assistance from the treating SLP, family or nursing staff during a study, but unless this assistance is requested we must ask all those in attendance of the MBSS to stand behind the lead wall and not up with the DiagnosTEX SLP and patient.  This allows us to do our job adequately, reduce the amount of distraction to the patient in such close quarters, and also limit the amount of people exposed to the radiation during the MBSS. The safety guidelines established by the National Council of Radiation Protection (NCRP) with fluoroscopy states that “only persons whose presence is necessary shall be present during exposure”, and in this mobile environment that would be the DiagnosTEX staff and the patient in the back of the mobile clinic, unless additional assistance is necessary to complete the study. We thank you for your understanding and cooperation with these policies.

October Days to be recognized
6-12th – National Healthcare Food Service Week – www.ashfsa.org
7th-13th – Residents Rights Week  www.nursinghomeaction.com
25th – Make A Difference Day – a national day of helping others. www.usaweekend.com/diffday
19th-25th – National Healthcare Quality Week  www.nahq.org
National Brain Injury Awareness Month  www.biausa.org
National Physical Therapy Month  www.apta.org

Patients Following through with Strategies If a patient is able to follow compensatory strategies for safe PO, then the follow through should be consistent as it would be required through their entire meals or any PO given.  If we see the following stated on a history form “sometimes, maybe, inconsistent, not sure, questionable”, we will question if the patient is appropriate for consistent follow through with strategies during PO. Strategies will be assessed by a DiagnosTEX SLPs for appropriateness if warranted for the swallow pathology, and options with and without strategies may be given on the report, but for a strategy to be effective it must be completed adequately and consistently to be effective on the texture on which it is being used. During an MBSS, a diet recommendation will be made of the safest consistency for the patient based on the consistent pattern and behavior during the study.

Power of Attorney – POA
We have recently received letters and phone calls from family members stating that they have had POA and that we provided MBSS services to a family member without the POA’s consent. The facility provides us with a signature on the DiagnosTEX consent form from either the patient or the family.  This does need to be signed by the POA if the patient has one.  We do review these files after we receive our required paperwork from the facility or HH agency.  In the aforementioned cases, in those where we completed the study, we did not find anything noting that patient was unable to consent or accept financial responsibility for the service.  We are referring these issues back to the HH agencies and the facility making the MBSS referrals and filling out the DiagnosTEX paperwork. Please make sure the person responsible for the medical decisions of the patient is the one who signs the DiagnosTEX consent form. Thank you for your help with this.

New DiagnosTEX SLP Handout/Reference Sheet
Our new October handout is on REFLUX.  Ask for yours next time we see you!

Dysphagia Tidbit –Diverticulums A Zenker’s diverticulum occurs at the pharyngeal esophageal junction. The most common site is between the oblique and horizontal fibers of the cricopharyngeal muscle through a triangle area known as the Killian’s triangle.  This area is only one of the several possible sites of weakness and potential herniation at the pharyngeal-esophageal junction.  Another less common site for hernitation is through the Laimer’s triangle, bordered superiorly by the cricopharyngeal muscle and inferiorly by the circular and longitudinal fibers of the cervical esophagus.  A Zenker’s diverticulum always originates from the posterior wall of the pharynx.  As it enlarges it tends to flop to one side, more commonly to the left.  It bulges inferiorly as it enlarges, thereby retaining food debris.  As the neck is higher than the diverticulum itself, it tends to collect ingested particulate matter (peas, corn etc.) and the patient may regurgitate undigested particles several hours after eating. Multiple swallows often occur in an attempt to clear the pharynx.  There is also a potential for overflow aspiration.  Below the diverticulum the cricopharyngeal muscle almost always appears prominent and large diverticulum may compress and displace the cervical esophagus.  The pathogenesis of the Zenker’s diverticulum remains unclear, although incoordination between pharyngeal contraction and cricopharyngeal opening may be a contributing factor. (B. Jones, 200 )