The Pulse

Ed M. Bice, M.Ed., CCC-SLP

Recent Posts

Mastication

Posted by Ed M. Bice, M.Ed., CCC-SLP on Dec 3, 2019 2:20:13 PM

As speech-language pathologists (SLPs) we often make diet recommendations. The unfortunate reality is we have scant information to direct these decisions. There is some evidence concerning the impact of volume and viscosity on swallowing kinematics (Barikroo, 2015; Chi-Fishman, 2002; Miller, 1996; Nagy, 2015; Watts, 2015). However, a systematic review (Steele, 2015) revealed little evidence to guide practice with respect to different degrees of modifying solid foods for patients with dysphagia. This means SLPs must rely on the sound understanding of the mastication process to make these decisions. Unfortunately, the system is quite complex and difficult to evaluate. This article represents the first of a series related to mastication that will address how mastication works and some possible assessment methods. Armed with this knowledge, SLPs may formulate more informed recommendations as part of a comprehensive patient care plan.

Read More

Topics: Dysphagia

Your Wet Voice Makes Me Uncomfortable

Posted by Ed M. Bice, M.Ed., CCC-SLP on Nov 22, 2019 1:16:17 PM

In the previous two articles in this series we examined the evidence concerning the clinical indictors of coughing and a runny nose. The conclusion was, both indicators provide us with weak information concerning swallowing function. In this edition, the evidence for wet vocal quality as a meaningful clinical finding will be discussed.

Read More

Topics: Dysphagia

Hand Me a Tissue: Rhinitis in the Geriatric Population

Posted by Ed M. Bice, M.Ed., CCC-SLP on Oct 29, 2019 10:09:04 AM

Therapist have often relied upon “clinical signs” to assist in determining if a patient is experiencing aspiration. Those signs have included coughing (see "Cough Up The Facts"
previous blog post), throat clearing, wet vocal quality, runny nose, and many others. There is very little empirical evidence to support the correlation of “clinical signs” to an episode of aspiration. A runny nose is often considered to be a salient sign of aspiration; perhaps this is an over generalization.

Read More

Topics: Dysphagia

Cough Up the Facts

Posted by Ed M. Bice, M.Ed., CCC-SLP on Aug 27, 2019 4:08:14 PM

Speech Pathologists who treat dysphagia often rely on a patient’s cough as a marker of aspiration. Other healthcare professionals have been educated that coughing is a sign of swallowing difficulty. How accurate is this statement in the geriatric population and what are other reasons a patient may be exhibiting a cough?

Read More

Topics: Dysphagia

Clinical Competence

Posted by Ed M. Bice, M.Ed., CCC-SLP on Jul 23, 2019 10:31:08 AM

As speech language pathologists, we are all familiar with the word “competence.” After a good deal of time invested in educational pursuits followed by a nine-month period of supervision, we are awarded our Certificate of Clinical Competence (CCC) from the American Speech Language and Hearing Association (ASHA). The reality is, when I received my CCC, I could hardly consider myself competent in any area of practice.

Read More

Topics: Dysphagia

Rethinking Aspiration Pneumonia

Posted by Ed M. Bice, M.Ed., CCC-SLP on Apr 17, 2019 11:44:47 AM

I am often surprised to learn that terms and concepts I use on a regular basis are different than
I thought. A common term that I have misunderstood for many years is “aspiration pneumonia.”
Recent reading has led me to a new understanding of this term.

Read More

Topics: Dysphagia

Exercise in Swallowing Therapy (Part 3 of a 3-Part Series)

Posted by Ed M. Bice, M.Ed., CCC-SLP on Jan 9, 2019 6:34:48 PM

This is the third and final installment of our “Exercise in Swallowing Therapy” series. This article will examine some commonly used interventions in light of exercise principles. But first, a quick review. In order to be considered an exercise the activity must meet certain criteria (for more information refer to the two previous articles).

Read More

Topics: Dysphagia

Exercise in Swallowing Therapy (Part 2 of a 3-Part Series)

Posted by Ed M. Bice, M.Ed., CCC-SLP on Dec 16, 2018 7:53:02 PM

In the first installment of “Exercise in Swallowing Therapy” the roles of overload and adequate
duration of therapy were discussed. In this second installment, additional exercise principles of intensity progression and repetition are described.

Read More

Topics: Dysphagia

What About My Clinical Judgement?

Posted by Ed M. Bice, M.Ed., CCC-SLP on Sep 24, 2018 5:28:59 PM

Recently I was engaged in a conversation related to the ability of a speech pathologist to clinically determine swallowing pathophysiology. A therapist responded she had paid a great deal of money for her degree and if she could not rely on her “clinical judgement” to accurately diagnose patients with dysphagia she had wasted her money.  I was not sure how to respond. However, after some reflection, here is my thoughtful response.

Read More

Topics: Dysphagia

Exercise in Swallowing Therapy (Part 1 of a 3-Part Series)

Posted by Ed M. Bice, M.Ed., CCC-SLP on Aug 27, 2018 11:21:37 AM

Swallowing interventions take several forms. One tool in the Speech Language Pathologist (SLP) toolbox is compensation, postural and behavioral interventions that impact the kinematics of the swallow. The most common compensatory technique is the chin down posture. An example of adaptation would be, the patient consumes a pureed diet due to dysphagia. Instead of fixing the problem, the environment or stimulus remains indefinitely modified. The most valuable tool, and often the most under-utilized item, in the therapist’s toolbox is rehabilitation.

Read More

Topics: Dysphagia

Welcome to our NEW Blog - The Pulse

We are the nation's leading rehab solutions provider, delivering proven, evidence-based programs to improve clinical outcomes and yield greater patient satisfaction in an efficient and cost-effective manner across the care continuum. 

Empowering PT/OT/SLPs and Nurses.

Helping millions of patients nationwide.

At The Pulse we will share important updates from our team including:

  • Clinical Tips
  • Patient Successes
  • Employee Spotlights
  • Industry News
  • White Papers

Subscribe Here!

Recent Posts