The Pulse

Evidence Based Practice in Swallowing Rehabilitation - 3 Part Series

Posted by Valerie Middleton, MA CCC-SLP on Dec 19, 2020 11:05:11 AM

Not unique to the field of Speech-Language Pathology, integration of Evidence Based Practice (EBP) is a hot topic and is essential in ensuring we are practicing at the top of our profession. Let’s begin by reviewing the three characteristics comprising the EBP triangle as outlined by the National Joint Committee for the Needs of Persons with Disabilities (NJC): (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) the perspectives of individuals with severe disabilities and their families and friends to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (NJC, n.d.). Over the next few months, we will discuss each of these areas in more detail. Although patient value and perspective is listed last, we will address this first, as this is an area worth consistent reflection and application.

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Topics: Dysphagia

Speech-Language Pathologist and the Use of Advanced Technology in Cardiopulmonary and Airway Disorders

Posted by ACP - Accelerated Care Plus on Sep 1, 2020 5:43:28 PM

Speech-language pathologists (SLPs) are commonly involved in the rehabilitation of patients with cardiopulmonary disorders. Patients hospitalized with respiratory diseases such as COPD and heart failure (HF) are identified as at risk for development of oropharyngeal dysphagia. Additionally, patients who experience prolonged endotracheal intubation have an increased risk of developing dysphagia. (Malandraki et al., 2016) This is often seen in patients hospitalized for COVID-19.

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Topics: Dysphagia, Cardiopulmonary

Improving Swallow Ability with sEMG and Exercise

Posted by ACP on May 27, 2020 3:19:23 PM

Patient Information: Male, Age 65

Diagnosis: Stroke / Oropharyngeal Dysphagia

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a stroke. He was diagnosed with oropharyngeal dysphagia (difficulty swallowing). His swallow initiation was inconsistent and he had difficulty managing his own secretions. He could not take any food or liquid by mouth and a feeding tube was placed. Prior to his stroke, he ate a regular diet.

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Topics: Dysphagia, Patient Success Story

Improving Swallow Ability Using sEMG and Exercise

Posted by ACP on Dec 9, 2019 12:13:18 PM

Patient Information: Female, Age 69

Diagnosis: Heart Failure / Dysphagia

History: This woman, a long-term rehab center resident, was admitted to the hospital due to heart failure which resulted in dysphagia (difficulty swallowing). A feeding tube was placed and she was not allowed to eat or drink by mouth. Following hospitalization, she was referred to speech therapy with a goal to return to eating a regular diet and drinking thin liquids independently in the dining room.

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Topics: Dysphagia, Patient Success Story


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.

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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.

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Topics: Dysphagia

Improving Swallowing Ability Using Electrical Stimulation, sEMG, and Exercise

Posted by ACP on Nov 19, 2019 3:36:43 PM

Patient Information: Male, Age 77

Diagnosis: Oropharyngeal Dysphagia / Hypoxic Respiratory Failure / Childhood bulbar polio
with paralyzed vocal cord

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Topics: Dysphagia, Patient Success Story

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.

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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?

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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.

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Topics: Dysphagia

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