September 2008 Newsletter




Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
September 2008
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator: CHANGE
When you see Boundaries as Opportunities, the world becomes a limitless place.
August Conferences WOW!  We had some great turnouts!  It was so fun to get together with everyone!  Thank you for your support and spending your Saturday with us!

FYI -Upcoming in October – I have been invited by SPAND to repeat the course Strategize with Strategies, 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 bachelors 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 at the new Region 10 Abrams location at 904 Abrams Road in the Pecan Room.  You can check out the website at .  If you are interested in attending, email them at to notify them that you are coming and then you can pay at the door. They will accept cash or check, no credit cards.

Dates to remember this month
1st  – LABOR DAY HOLIDAY – Rest, relax and enjoy the day off! We will!
7th – Grandparents Day – HUG A GRANDPARENT TODAY, EVEN IF THEY ARE NOT YOURS   Celebrated after Labor day since 1978.
7th-13th – National Healthcare Housekeeping Week
7th-13th – National Assisted Living Week
21th-27nd – National Rehabilitation Awareness week
24th – National Women’s Health and Fitness day

Upcoming Holidays  DiagnosTEX will be closed on Labor Day, Monday September 1, 2007.  Also all of the DiagnosTEX SLP’s will take a CEU education day on Friday September 12th, so we will run no vans that day.  We continually further our education to serve you better. We will do our best to meet all your MBSS needs in and around that time as efficiently as possible.  Please consider this when scheduling your MBSS that week.


Last month we had a handout on TASTE.  This month it is an Oral Phase Reference Sheet.  Ask for yours next time we see you.  You can also find these in our Clinical Café on our website at

TRANSFER of your patients to the mobile clinic –DiagnosTEX technicians are available to transfer the patient from the building to the mobile clinic.  Our techs are not responsible for transferring the patients from their beds to a wheelchair.  This is why we call 15 min ahead of time, so the facility can prepare and get the patient up and ready to be transferred outside to the mobile clinic.  DiagnosTEX does not become liable for the patient until they enter our mobile clinic.  Due to the liability issues and us not being an employee at your facility, please do not depend on our technicians to get the patient up for you. This is the responsibility of the facility.  If the patient is not up and ready for us when we arrive, we can wait for a short period of time before we will have to continue on with our schedule and reschedule the patient for another day.

ADD-ONS We have many, many requests to do add-on’s when we arrive at an already scheduled facility.  We like to do them for you if we can and time allows.  Recently we have had add-on’s that have not been called into the office to be checked for eligibility and coverage.  If you know there is an add-on, this needs to be done before we arrive at the facility. A lot of work by the office staff goes into assuring there is a payment source for this requested study. We can no longer add on patients before our office staff checks for insurance authorization, Medicare eligibility or any other issues related to a Hospice patient or VA.  Thank you for your help with this so we can help you, by adding on your patient while we are there.

Dysphagia Tidbit – No cough The evolution of our profession and management of dysphagia is bringing us to new and exciting information.  Over the years a series of compensatory strategies have been developed to immediately reduce risks for short term management.  They will always have an important place in our clinical environments. Emerging research in rehabilitation of the dysphagia patient is making things increasingly clear that diagnostic precision and quality is necessary and mandate for rehabilitative effectiveness.  Treatment strategies should be introduced during an MBSS to determine the effectiveness of the strategy prior to implementation.  Not all strategies can be appropriately evaluated at bedside.  A lack of a cough can not be equated with resolution of penetration and aspiration, a patient may no longer cough when a thickened liquid is given with a strategy.  Daniels et. al (1998) noted increased silent aspiration with barium (thicker consistency) on an MBSS as opposed to overt signs of aspiration noted with water in the same patients.  So the simple solution of thickening liquids, may not be eliminating penetration or aspiration, just masking the overt signs.  Example – I observed frank and profound aspiration during and after the swallow on a trach patient under fluoro last month on 1 tsp of nectar and 1 tsp of thick puree. This particular patient coughed immediately on the frank aspiration of a tsp of nectar thick liquids, but was completely silent on the frank aspiration of the tsp of thick puree. Let DiagnosTEX be your diagnostic precision and quality to ensure your rehab effectiveness!

Reference: Daniels, S, Brailey k., &  Priestly, D. H., Herington, L.R., Weisberg, L.A. & Foundas, A.L. (1998) Aspiration in patient s with acute Stroke, Archives of Physical Medicine and Rehabilitation, 79, 14-19.