Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Seek the lofty by reading, hearing and seeing great work at some moment every day
CEU COURSE – Rehab Synergies CEU Opportunity in Arlington, on October 22, 2011. There is a limited number of seats open to the public, do not delay in registering. Please see registration form included for information on how to register. Tracheostomy 101 will be presented by Ronda Polansky M.S. CCC-SLP and Pam Ragland M.S. CCC-SLP.
A tracheostomy tube will present a wide array of challenges for the SLP who may be ill-equipped or unfamiliar with the assessment and treatment of the associated vocal and swallowing challenges imposed upon the patient post-insertion. The patient’s ability to produce clear uninterrupted phonation, manage secretions while improving swallow function/reduce risk of aspiration will be the SLP’s primary focus when working with the entire interdisciplinary team (Respiratory Therapist, Nurse, Physician, etc). This introductory course will provide a review of the anatomical structures, complications and contraindications associated with the surgical insertion of a tracheostomy tube. Participants will review symptoms associated with trach-induced dysphagia along with the various types of trachs currently being utilized by the medical field. Assessment techniques along with practical treatment techniques and incorporating speaking valves, will be included. Co-morbidities and other medical information often associated with trach-tubes will be presented. SLP’s will have an opportunity to review Modified Barium Swallow Studies featuring patients with tracheostomy tubes and pose questions.
Continuing Education On-Line programs – Are you or your colleagues looking for affordable, advanced-level CE programs on dysphagia? Programs you can view at your convenience? Visit the site: www.swallowingdisordersceu.org <http://www.swallowingdisordersceu.org/> for detailed information about the courses offered. Group discounts are available.
The newest addition is Swallowing After Surgical and Non-surgical Organ Preservation in Head and Neck Cancer Patients. This course is presented by Jan S. Lewin, Ph.D., BRS-S, Katherine A. Hutcheson, Ph.D. & Denise A. Barringer, M.S., BRS-S of MD Anderson Cancer Center in Houston.
Other courses currently available include:
- Aspiration Pneumonia and Pneumonitis – Jim Coyle, Ph.D., CCC-SLP, BRS-S
- The Effects of Sarcopenia and Frailty on Swallowing Function in the Elderly – Joe Murray, Ph.D., CCC-SLP, BRS-S
- Accuracy and Reliability of Swallowing Assessments – Joe Murray, Ph.D., CCC-SLP, BRS-S
- Dysphagia Research Consumerism- How to read research – Jim Coyle, Ph.D., CCC-SLP, BRS-S
- Disease Management and Dysphagia in the Acutely Ill – Nancy B. Swigert, M.A., CCC-SLP, BRS-
- Medical Interventions and Dysphagia in the Acutely Ill – Nancy B. Swigert, M.A., CCC-SLP, BRS-S
- Dysphagia in Head and Neck Cancer Patients – Paula A. Sullivan, M.S., CCC-SLP, BRS-S
- Dysphagia at End of Life – Paula A. Sullivan, M.S., CCC-SLP, BRS-S
- Meet the Masters “Oral care and the Association with Aspiration Pneumonia in Patients with Dysphagia.” Speakers include Susan Langmore, Kenneth Shay, Paul Marik and Tessa Goldsmith.
Medicare changes, healthcare changes and the Electronic Health Record – DiagnosTEX is subject to all changing healthcare requirements as any other medical facility. As most of you know the Electronic Health Record (EHR) is the future of healthcare and we are required to implement it as well. Our reports will be formatted differently due to this. The same information will be in it, but you will notice a significant change in the looks/format of both the doctors and SLP report. I expect that we will have much feedback and some will not like it and some will not be bothered by it. This change is requiring flexibility by all involved here at DiagnosTEX and we ask the same of you. Please be secure in the fact that the information documented will be the same as we have always provided, yet it will look different on paper. You will begin to see this soon as this new report will both SLP and Doctor reports be implemented before the end of year between October and November. Please also be patient with our staff as we adjust to using the new system on the mobile clinic.
Flu season is coming up – We ask that if you or a family member or even the patient is ill with an active cough and fever that you do not attend the MBSS on the mobile clinic or reschedule the patient, as we do not want to contaminate our small area. We see many fragile individuals in a day in this small environment and also our staff is small and their absence is greatly felt if they become ill. Please be considerate during this flu season and refrain from being on the van if you or a family member does not feel well. If the patient is ill, please reschedule for another day. Thank you!
Dysphagia Tidbit – ALS and treatment – It is contraindicated to do strengthening exercises with someone with ALS, as it fatigues the muscles, not strengthens them due to the nature of the disease. If it is a bulbar type ALS, the physical condition will likely progress rapidly and within 6 months eating will not be a viable option, as aspiration on own secretions will likely effect respiratory status as well. To facilitate swallowing with ALS, compensatory methods can be improved by change of posture. Patients with tongue weakness or reduced tongue mobility can tilt their heads backwards to support the transport of the food bolus by gravity. Problems with mastication can necessitate a change of diet to a fluid or moist consistency. If the problem is associated with a delayed triggering of the pharyngeal swallow or leaking of food into the pharynx, chin tuck (tilting the chin down before swallowing) is a helpful compensatory change of posture. To avoid drooling of food or liquids, patients should be encouraged to seal their lips with their hand. In aspiration is caused by weak laryngeal closure or a delayed swallowing reflex is diagnosed the supraglottic swallowing maneuver may help to close the vocal cords during swallowing (glottal closure).. The technique is appropriate for patients with minor oral, laryngeal and/or respiratory dysfunction. Sensorimotor exercises aimed at partial restitution of impaired functions might provide some limited benefits to patients with ALS who have swallowing impairments, although intensive exercises might merely exhaust the weakened muscles. If the triggering of the swallowing reflex is delayed or patients show impaired oral bolus control, tactile or thermal stimulation of the anterior faucial pillars and the tongue before meal times might produce a temporary improvement. Passive pressure on the hyoid bone (either by the patient or by an assisting nurse or relative) during eating can support the elevation of the tongue and thereby trigger the swallowing reflex. In mild or moderate dysphagia, dietary modification has been shown to be an effective approach. The triggering of the swallowing reflex can be enhanced by emphasizing taste or temperature; for example, drinks can be made easier to swallow by cooling them to below room temperature. Special eating or drinking aids can also be employed. In patients whose swallow is delayed, thickened fluids are usually better tolerated than thin fluids as they tend to move more slowly through the oral cavity. For these patients, it is recommended that thickeners in powder form are added to drinks to minimize the risk of penetration and aspiration. Soft textures or puréed food can compensate for a poor oral preparation phase and ease oral and pharyngeal transport. Liquid supplements can be helpful, but beyond a certain stage in the disease choking can become frequent, especially with thin liquids. Clinical and instrumental investigations and are required to establish whether an individual patient will benefit from fluids or thickened drinks. Thick mucous secretions are frequently reported by patients with ALS and can be a sign of dehydration. Dehydration can occur because patients are unable to swallow fluids or are drooling large amounts of saliva that would usually be swallowed and reabsorbed. Hydration is, therefore, an important first step in the treatment of these patients. Liquefaction of thick mucous secretions by use of Nacetylc