What Every Therapist Needs to Know About Dysphagia

Karen Sheffler, MS, CCC-SLP, BCS-S

Online Course

Includes all course content in digital format

Prerequisites Required
6 hours - Provided by Summit Professional Education

Item: physi-ONDEMANDGDYSKS1

Description

This course will review the swallowing basics through use of dynamic, multi-media lectures and hands-on labs.Labs will explore oral-sensorimotor examinations, case history taking, thickening liquids, food consistency testing, complying with the new IDDSI standards, and more. Participants will dive into challenging ethical and end-of-life topics in small group discussions. Therapists should no longer feel like a novice or too scared to ask your questions during a more advanced course setting or in online forums. Let's answer those questions and provide resources to guide your quest for more training. Our aim is to take you from "not knowing what you do not know," (which in medicine is pretty scary) - to knowing your strengths and weaknesses in the dysphagia knowledge base. We want to provide a framework to help you fill in your training gaps in the future, so that you can provide your best evidence based patient-centered care possible.

Highlights

  • Improve your ability to perform thorough swallowing evaluations; maximize the utility of the clinical bedside swallowing evaluation to develop hypotheses that will guide further testing
  • Develop comprehensive evidence-based practice treatment programs, which are compensatory and rehabilitative to improve patient outcomes.
  • Utilize the most appropriate instrumental swallowing assessments such as Video fluoroscopy (MBSS) and Video endoscopy (FEES)
  • Aspiration pneumonia prevention and aspiration precautions strategies you can use the next day to reduce risks, while not sacrificing quality of life
  • Hands-on labs to thicken liquids and to understand the new food and liquid diet framework from the International Dysphagia Diet Standardization Initiative (IDDSI)
  • Become an effective advocate for dysphagia awareness and to obtain the needed services for your patient

Learning Objectives

  1. Classify potential causes and impacts of dysphagia.
  2. Provide thorough justification as to why a medical team should be concerned about dysphagia in a given patient.
  3. Explain the 4 interacting phases of dysphagia, referring to resources and charts that aide in the recall of the muscles and cranial nerves involved.
  4. Describe what information a bedside swallowing evaluation can and cannot provide.
  5. Advocate for the appropriate instrumental examinations when needed to answer pertinent questions based on the hypotheses formed from thorough chart reviews and on the bedside examination.
  6. Select dysphagia management strategies that are tailored to the person's deficits, creating a management that includes all pillars of treatment.
  7. Apply patient-centered care options for eating/swallowing in order to reduce aspiration pneumonia risk in a curative focus or reduce discomfort in a palliative care focus.

Course Content

What Every Therapist Needs to Know About Dysphagia
SCORM Package
Next Steps
Module
  1. Causes and Impacts of Dysphagia
    1. Define dysphagia
    2. Causes of dysphagia
    3. Are you ready for a fun and fascinating field?
    4. The impact of dysphagia
    5. Health and nutritional impacts
    6. Aspiration pneumonia and pneumonitis
    7. Criteria for referral to speech-language pathology
  2. Dysphagia and Normal Swallowing
    1. Let's talk about bad design!
    2. Video examples of safety and efficiency swallowing problems
    3. Analyze the 4 interacting phases of the swallow in our snack lab
    4. Muscles and cranial nerves
    5. Oral-sensorimotor exams based on cranial nerves
      6. Hands-on Lab
  3. Swallowing Evaluations and Instrumental Swallowing Assessments
    1. Clinical Bedside Swallowing Evaluation (CBSE)
      1. Chart reviews and case history forms
      2. What a thorough CBSE can reveal
      3. What a CBSE cannot reveal
      4. Lab: The art of the interview for a complete case history
    2. Instrumental exams: No "one" gold standard
      1. Why do an instrumental exam?
      2. General principles of the instrumental
      3. It is not all about the big-bad "A" word (Aspiration)
      4. It is not all about the bolus of food, liquid, or pill
      5. Why is the person having trouble swallowing and what can we do about it?
      6. Ask for therapy recommendations based on your patient's study
      7. Video Fluoroscopic Swallow Studies (VFSS, aka Modified Barium Swallow Study/ MBSS)
      8. Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
      9. Referrals: Other tests by the deglutition team
      10. Range of "normal" for swallowing safety andefficiency
      11. Lab: Viewing videofluoroscopic swallow studies that correspond to the case histories shared earlier
      Hands-on Lab
  4. Dysphagia Treatment and Management: The Dysphagia Toolbox
    1. Pillars of dysphagia management
      1. Compensatory strategies: It's not all about the chintuck!
      2. Diet modifications: Are we just the diet police?
      3. Rehabilitation: Connecting exercises to specific deficits
      1. Collaboration with registered dietitian
        1. Sarcopenia, failure to thrive, frailty
      2. Collaboration with the entire team (e.g., RN, OT, PT, physicians/NPs/PAs) and making appropriate referrals (e.g., GI, ORL, neurologist)
      3. Diet modification lab
        1. International Dysphagia Diet Standardisation Initiative (IDDSI) framework for solids and liquids
        2. IDDSI food testing
        3. Play with your food
        1. Thickened liquids lab
          1. IDDSI flow test
          2. Compare starch-based to gum-basedthickeners
      Hands-on Lab
      1. Dysphagia and Stroke
        1. Importance of the nursing swallow screen
      2. Dysphagia Risks and Complications
        1. Does aspiration = pneumonia?
        2. Recipe for aspiration pneumonia
        3. Health-status model
        4. Ways to reduce the risk for aspiration pneumonia
        5. Patient-centered care
          1. Options and the safer diet
          2. Do we have to sacrifice quality of life?
          3. Water!
        6. Discussion lab on goals of care: Curative versus palliative (small group discussions)
          1. The Conversation; Palliative care & the SLP
          2. PEG tubes and dementia
Karen Sheffler, MS, CCC-SLP, BCS-S, has over 20 years of experience as a medical speech-language pathologist, specializing in dysphagia since 1995, when she graduated from the University of Wisconsin-Madison. She obtained her Board Certification as a Swallowing Specialist (BCS-S) in 2012. In 2014, she started SwallowStudy.com, which is a dysphagia resource for patients and professionals. Karen has worked in acute care, rehabilitation centers, skilled nursing facilities, and in home health care. She currently works at two different hospitals in the Boston area, owns her own dysphagia consulting business, and provides dysphagia expert services to companies and law firms. Karen also performs peer reviews for DysphagiaGrandRounds.com and the American Board of Swallowing and Swallowing Disorders (ABSSD). Believing in constant continuing education, she has been awarded the ASHA Award for Continuing Education 5 times. She is a member of ASHA's Special Interest Group 13, the National Foundation of Swallowing Disorders (NFOSD), and the Dysphagia Research Society (where she is a member of the Website, Communications and Public Relations Committee).

DISCLOSURES

FINANCIAL: Karen Sheffler is compensated as a consultant and presenter for Hormel Health Labs, and she sits on a Hormel advisory council. She is compensated as an instructor by Summit and SpeechPathology.com/Continued.com. Karen has received or will receive an honorarium for presenting on IDDSI for Hormel, Becky Dorner Associates, and Martin Bros. Distributing Co, Inc. Karen Sheffler's website, SwallowStudy.com, has an affiliate relationships with Medbridge and CWI (which sells dysphagia products). She has performed paid peer reviews for MedBridge.

NONFINANCIAL: Karen Sheffler is the founder and developer of the website SwallowStudy.com. She is a member of the ASHA Special Interest Group 13 and the National Foundation of Swallowing Disorders (NFOSD). She is also a member of the Dysphagia Research Society. She has performed volunteer peer-reviewing for DysphagiaGrandRounds.com and for the American Board of Swallowing and Swallowing Disorders (ABSSD). She is an IDDSI Champion, promoting the International Dysphagia Diet Standardization Initiative since 2014.

Summit receives financial support for this course from Physitrack

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