September 2013 Newsletter
Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
September 2013
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
With Great Respect,
We pay tribute to the creation of our nation’s strength, freedom and leadership….
The American Worker!!!
Back to school time for our kids!
Upcoming Holiday – DiagnosTEX will be closed on Labor Day, Monday September 2, 2013.
Please consider this when scheduling your studies. We will operate Tuesday – Friday that week.
Interesting fact: The first observance of Labor Day is believed to have been a parade of 10,000 workers on Sept. 5, 1882, in New York City, organized by Peter J. McGuire, a Carpenters and Joiners Union secretary. By 1893, more than half the states were observing “Labor Day” on one day or another, and Congress passed a bill to establish a federal holiday in 1894. President Grover Cleveland signed the bill soon afterward, designating the first Monday in September as Labor Day.
What are we celebrating? 155.2 million people 16 and older in the nation’s labor force in June 2012
Source: U.S. Bureau of Labor Statistics
Speak Out! Parkinson’s Voice Project RICHARDSON, TX – Parkinson Voice Project is proud to announce “Never Grow Up” starring Cathy Rigby with the LOUD crowd. Saturday September 28, 2013 at 2pm. The Heights Baptist Church. Tickets available online at Parkinson’s Voice Project (www.parkinsonsvoiceproject.org, or call 469-375-6500.
Dates to remember in September:
National Grandparent’s Day – www.grandparents-day.com
National Women’s Health and Fitness Day – www.fitnessday.com
National Assisted Living Week – www.nalw.org
National Rehabilitation Awareness Week – www.nraf-rehabnet.org
Healthy Aging Month – www.healthyaging.net
Alzheimer’s Memory Walk (September-November) – www.alz.org
New Audit Entity –CMS is developing a new integrity contractor called Unified Program Integrity Contractor (UPIC). These contractors will focus on both Medicare and Medicaid. The ZPICs and the MACs will be folded into the UPIC. Recovery auditors will remain in place and CMS will consolidate all of its Medicare and Medicaid into one data base.
New DiagnosTEX handout! Be Consistent with Diet Consistencies! Examples of mixed consistencies, sticky consistencies, non-cohesive consistencies, soft regular and thin liquids. Get yours next time we see you! Use for education with your dysphagia patients and families as well as dietary staff.
New Dysphagia Product – The Dysphagia Test Kit – This kit is designed for use by SLP’s in hospitals, SNF, OP, and home health settings for conducting BSE or MBSS. This kit allows for standardization as well as an organized, time saving approach to conducting evaluations. The kit contains everything you need for an evaluation in one kit per patient. It is economical, convenient, promoting infection control, procedural standardization, as well as optimized productivity. It includes various liquid and food consistencies, spoons, straws, cups, tongue blade etc. in one packaged kit for easy carrying. For more information and to order call 1-877-728-7122. Provided exclusively by Home Healthcare Solutions,Inc.
Dysphagia Research Review – Logemann, J.A. et al (2008) A randomized study in three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s Disease. Journal of Speech. Language and Hearing Research, 51, 173-183. Doi:10.1044/1092-4388
Nearly half of surveyed SLPs report using thickened liquids for 25-75% of the patients they treat with dysphagia (Garcia, Chambers, and Molander, 2005). Inaccuracies in preparing liquids to target level thickness is an important part of training and education. Patients who may consume inappropriate modified liquids, including over thickened, may heighten their risks. Sensory analysis indicates that the addition of thickening product suppress flavor intensity, which may be an additional factor in overall compliance.
Logemann and colleagues compared thickened liquids to a chin tuck/chin down position for patients diagnosed with dementia and Parkinson’s’ disease. Results from their clinical trial of 711 patients found more immediate effect (elimination of aspiration) with thickened liquids in comparison to a chin tuck/chin down posture. Although honey thick liquids had a positive short-term effect, patients who consumed nectar thick liquids had a lower incidence of pneumonia across a 3 month period, which also highlights the level of modification as an important consideration to the patients’ health and safety (Robbins et.al, 208)
Dysphagia Tidbit – Muscular Dystrophy and dysphagia In honor of Jerry’s Kids and Labor Day weekend telethon – Although in theory any muscular disorder may present with impairment of swallowing, abnormalities of deglutition tend to predominate in some types of muscle disease. These include certain muscular dystrophies such as oculopharyngeal muscular dystrophy (OPMD), myotonic dystrophy (MD), and rare patients in the advanced stages of Duchenne muscular dystrophy (DMD). Inflammatory disorders such as polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM) can involve the muscles of deglutition. Certain metabolic myopathies, particularly mitochondrial myopathies, may present with impairment of swallowing.The patients affected with myopathy and dysphagia often present with subjective complaints of either choking on solids, or plain inability to swallow the food. Occasionally, patients comment on the fact that they cough frequently, particularly when drinking liquids. They may point to the upper cervical region or to the mid-sternal region depending on whether the esophagus is involved or not.In a subset of myopathic patients, the dysphagia is associated with impairment of the cricopharyngeal muscle function and its ability to relax, which then prevents the food from leaving the hypopharynx into the esophagus. This is termed cricopharyngeal achalasia. The patient may describe tightness in the throat, and may complain of pooling of secretions as well as develop insidious weight loss. Radiologic evaluation of the pharynx during barium swallow often shows this appearance of cricopharyngeal achalasia. This problem can occasionally be treated with a cricopharyngeal myotomy, and a muscle biopsy specimen from the cricopharyngeus sometimes can illustrate the diagnoses, particularly in the case of inflammatory myopathy, inclusion-body myositis, or oculopharyngeal muscular dystrophy. GI Motility online (2006) Published 16 May 2006Muscle disorders affecting oral and pharyngeal swallowing Safwan Jaradeh, M.D.