Part 2: Implementing Internal and External Evidence
We began our discussion on employing evidence-based practice (EBP) in swallowing rehabilitation during the spring newsletter, with careful consideration for upholding ethics in treatment and focusing on patient perspective. Let’s continue by delving deeper into incorporation of evidence in dysphagia therapy. ASHA defines the implementation of evidence as “The best available information gathered from the scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence).” ASHA’s recommended EBP process includes the following steps: Frame the clinical question, gather evidence, assess the evidence, and make the clinical decision (ASHA 2020).
If our CSE indicates presence of dysphagia or aspiration, we will move forward with gathering additional evidence during an instrumental swallow study. During the FEES or VFSS, we not only are able to confirm presence of dysphagia and/or aspiration, but can identify the specific physiological impairments and introduce respective compensatory and treatment techniques. This may include postural changes, swallowing maneuvers, and/or modifying bolus properties. Utilizing these patient-specific interventions for internal evidence collection during assessment sets the stage for carry over into an effective EBP treatment plan (Logemann, 2011).
American Speech-Language-Hearing Association. (2020). The Evidence-Based Practice Process. https://www.asha.org/research/ebp/evidence- based-practice-process/
McCullough, G.H. (2002). One Application of Evidence-Based Medicine to Clinical Examinations of Swallowing. Perspectives on Swallowing and Swallowing Disorders. Dysphagia. https://doi.org/10.1044/sasd11.2.9
Logemann, J.A. (2011). Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care? Perspectives on Swallowing and Swallowing Disorders. Dysphagia. https://doi.org/10.1044/sasd20.4.121
Drisko, J. W., & Grady, M. D. (2019). Step 3 of EBP: Part 1—Evaluating Research Designs. Evidence-Based Practice in Clinical Social Work. Essential Clinical Social Work Series. https://doi.org/10.1007/978-3-030-15224-6_6
Robbins, J., Butler, S.G., Daniels, S.K., Gross, R.D., Langmore, S., Lazarus, C.L, Martin-Harris, B., McCabe, D., Musson, N., Rosenbek, J. (2008). Swallowing and Dysphagia Rehabilitation: Translating Principles of Neural Plasticity Into Clinically Oriented Evidence. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/1092-4388(2008/021)