Caitlyn is an amazing SLP who chooses to know instead of guessing how to help her patients with dysphagia. She is the perfect example of an SLP practicing at the top of her license. This all speaks for itself in the results she gets with her patients. Check out what she has to say about MDD!
Recently, a conversation I had with Mattie Murrey-Tegels, M.A. CCC-SLP was featured on her blog. Here is the link to check out the post.
I had a great time speaking with her on her podcast, The Missing Link for SLP’s about starting a FEES program and making the decision to work for myself. I am always ready to share my passion for dysphagia evaluation and treatment. Check out the post linked here and let me know what you think! Listen to the podcast here!
I am often asked why or how I started Midwest Dysphagia Diagnostics. The short answer is that I firmly believe that all people deserve high quality, evidence based evaluation and treatment of their swallowing. The longer answer involves multiple beliefs that I have. Eating and drinking are two things that really are important to all of us. We like to have meals with our families at holidays, like to go out to coffee with the guys every Thursday morning, or use dinner time as the one time during the day when we can sit down and relax and talk to our kids. Most of the social things that we do are around eating or drinking. When a person has dysphagia, they might feel like they miss out on these times and I’m not ok with that. I feel like we need to do better for our patients and that starts with high quality imaging. I won’t get into all of the evidence in this post- check out my other posts for that information.
I believe that time is of the essence with dysphagia treatment. If a person is not able to access timely imaging, we are wasting their time. And if this is someone that suffered a stroke, we know that time is really important. I cringe when SLP’s tell me that they had to wait a month for a MBSS at the hospital. This is not the hospital SLP’s fault, or anyone else for that matter. It is just the reality that hospitals are busy and there might only be one fluoro machine for the whole hospital. For that month, the patient is either just statically waiting, or they are receiving treatment that was planned based on a guess. Neither option is a good one. Or maybe that person gets sicker and sicker just waiting for the test. That’s not ok with me. That’s why I am available within 24-48 hours to come out and evaluate your patient.Â
I believe that we should practice at the top of our licenses and provide the most up to date, evidence based care that we can. I am always reading new articles, looking at case studies, and discussing cases with my peers to continue to learn. I also try to share what I learn with other SLP’s. Sometimes we don’t know better, but when we do, we need to do better.This is one of my favorite parts of my job. I love to talk with SLP’s around the state. I am definitely the person to talk to if you ever need an article. (Not everyone has multiple binders full of EBP…..?)Â
There are many rural communities in Iowa. I believe that everyone, wherever they live should have the same access to medical care. Some people would have to drive more than an hour to get to the nearest hospital with fluoro. Some even further. This distance can make it tricky in different weather conditions and if the person is medically fragile they may not be safe to be out of the facility for that long. That’s why I come to you. I am happy to drive as far as needed to provide this care to everyone.Â
I have to say that I love my job most days. Some days are very long, and running Midwest Dysphagia Diagnostics is not always that much fun (hello taxes). However, knowing the people that I have helped makes it all worth it. I really am passionate about dysphagia and I am always happy to talk over a case, offer an article, or anything else I can do to support all of the SLP’s treating dysphagia. If you ever need anything, please reach out!Â
#ScopeOn
This week is the first in a series about the Clinical Swallow Examination or CSE. I’ll start by talking about what is involved in the CSE. In future posts, the reliability, sensitivity, and specificity will be examined. (Spoiler alert….it’s not great). I will also discuss what information we can obtain from the CSE and when an instrumental examination is indicated.
So what makes up the CSE?Â
Chart ReviewÂ
This is a step that cannot be skipped. A thorough chart review can reveal risk factors for dysphagia and if there are other co-morbidities that may contribute to swallowing difficulty. It is also important to note whether or not the individual has been seen for dysphagia evaluation or treatment in the past. Make sure to also check out the meds list as we know that there are many medications that can contribute to or cause dysphagia (I’ll discuss this in a future post). If you have access to current lab values, make note of those as well (I’ll cover this too).
Patient Interview
It’s important to get the information from the source! Questions should be asked to determine what the patient thinks about their swallowing. Many people will initially deny having any difficulty swallowing only to report that they don’t eat meat and straws make them cough and bread sticks in their throat….during the interview. If the patient is unable to report, track down the main caregiver and ask them questions. In long term care, the CNA’s that are in the dining room with these patients hold a wealth of knowledge. During the interview, you can also get a better idea of what the patient’s wishes and goals of care are. Maybe the patient never wants a feeding tube, or maybe that one coke every day is what they live for, or maybe the patient wants to be able to eat a birthday cake on their birthday coming up in a month. (The birthday example is true and this patient was able to celebrate their birthday with a giant piece of chocolate cake!) During the interview, I also observe the patient to obtain even more information.Â
Cranial Nerve ExamÂ
Remember that one day in grad school where you were quizzed on all of the cranial nerves and what they control and what an impairment looks like? I definitely do! Did you think you would use this information every day? The Cranial Nerve Examination is one of the most important parts of the CSE. Knowing what nerve does what is incredibly important. Sometimes we SLP’s are the only ones to look at the cranial nerves and catch something not noted by the doctors. I make sure that at minimum I evaluate the nerves involved with swallowing. There are some wonderful resources for a review if you aren’t confident with your skills.Â
Cognitive Screen
Knowing a baseline of the patient’s cognitive abilities can guide the treatment plan. For example, if a patient is found to have mod-severe cognitive deficits, this individual may not be able to remember strategies on their own. Many times we are consulted for both a dysphagia evaluation and a cognitive-linguistic evaluation. I also will evaluate the patient’s ability to follow directions to make the instrumental examination run more smoothly.Â
Bolus trials
It seems like everyone has a different idea of what boluses to administer during the CSE. This is something I will dive into later. Personally, I use the Yale Three Ounce Water Challenge in every CSE. And good news!! It is now validated for use in long term care and other subacute facilities.Â
That are all the components that I include in a CSE. What do you do differently? What would you add? Would you skip anything? Let me know!
Next time I will discuss what info we can get from the CSE and what to do with it. Stay tuned!
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Until next time,Â
#ScopeOnÂ
KatieÂ
References:
Garand KLF, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment Across the Life Span: The Clinical Swallow Evaluation. Am J Speech Lang Pathol. 2020 Jul 10;29(2S):919-933. doi: 10.1044/2020_AJSLP-19-00063. Epub 2020 Jul 10. PMID: 32650662.
Ward, M, et al. Validation of the Yale Swallow Protocol in Post-Acute Care: A Prospective, Double-Blind, Multirater Study. Am J Speech Lang Pathol. 2020 May 1-7. https://doi.org/10.1044/2020_AJSLP-19-00147Â
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