1. Mythbusters: We should not be the SLPs we were 10 years ago!!
Jamie L Johnson, MA L/CCC-SLP, BCS-S
KSHA 2019
Thursday Sept, 25, 2019

2. How do we start? EVALUTIONS OF DYSPHAGIA Clinical Swallow Evaluation
Videoswallow Evaluation
Fiberoptic Endoscopic Evaluation of Swallow or FEES

3. SIGNS AND SYMPTOMSOF DYSPHAGIA

4. CLINICAL SWALLOW EVALUATION
What do you use to complete a clinical swallow evaluation?

5. Symptoms we listen for and watch for when we evaluate……..

6. The Cough

7. Recommendations

8. MODIFIED DIET
LIQUIDS
SOLIDS

9. Let’s talk WATER!

10. Swallowing Strategies:
Chin Tuck
Straws

11. Oral Care

12. Off to Radiology with you!

13. or a FEES….!

14. ASPIRATION!

15. PENETRATION!

16. THE RECOMMENDATIONS

17. THE TREATMENT PLAN

18. FEEDING TUBES
You can eat
You can aspirate

19. Shame on us!!

20. The Literature We should be on top of our game-the latest research
If we don’t our patients will!!

21. Modifying more than diets: Rethinking a common practice
Ed Bice, M.Ed, CCC-SLP
Co-Author Angela Van-Sickle
The Current State of Practice

22. The supposedly unsolvable sliding tile puzzle of dysphagia management Dysphagia Café Pamela Smith PhD CCC-SLP

23. Literature Review
Evidence Based Practice

24. References:
Andersen, U., Beck, A., Kjaersgaard, A., Hansen. (2013). Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (>18 years) with oropharyngeal dysphagia. European Society for Clinical Nutrition and Metabolism, 8(4), e127-e134.
Ashford, J. R. (2005, March). Pneumonia: Factors Beyond Aspiration. Perspectives in Swallowing and Swallowing Disorders (Dysphagia), 14,
Beck, A. M., Kjaersgaard, A., Hansen, T., & Poulsen, I. (2018). Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia – An updated clinical guideline. Clin Nutr, 37(6 Pt A), Retrieved from doi: /j.clnu
Bennett, J. A. (2000). Dehydration: hazards and benefits. Geriatr Nurs, 21(2), Retrieved from doi: /mgn

25. Castellanos, V. H. , Butler, E. , Gluch, L. , & Burke, B. (2004)
Castellanos, V. H., Butler, E., Gluch, L., & Burke, B. (2004). Use of thickened liquids in skilled nursing facilities. J Am Diet Assoc, 104(8), Retrieved from doi: /j.jada
Cichero, J. A. (2013). Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J, 12, 54. Retrieved from doi: /
Crary, M. A., Carnaby, G. D., LaGorio, L. A., & Carvajal, P. J. (2012). Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. Archives of physical medicine and rehabilitation, 93(7),
Feinberg, M. J., Knebl, J., Tully, J., & Segall, L. (1990). Aspiration and the elderly. Dysphagia, 5(2),
Feinberg, M. J., Knebl, J., & Tully, J. (1996). Prandial aspiration and pneumonia in an elderly population followed over 3 years. Dysphagia, 11(2),
Garcia, J. M., Chambers, E., & Molander, M. (2005). Thickened liquids: practice patterns of speech-language pathologists. Am J Speech Lang Pathol, 14(1), Retrieved from
Gosa, M., Schooling, T., Coleman, J. (2011). Thickened Liquids as a Treatment for Children With Dysphagia and Associated Adverse Effects A Systematic Review. Infant, Child, & Adult Nutrition, 3(6),

26. Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia, 13(2),
Leder, S. B., & Espinosa, J. F. (2002). Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia, 17(3),
Leslie, P. & Coyle, J (2020) Complex decisions involving gastrostomy feeding tubes: When you’re never right or wrong? Perspectives on Gerontology, December 2010, American Speech-Language Hearing Association; DOI: /gero
Lippert, W., Chadha, R., Sweigart. J. (2019). Things we do for no reason: The use of thickened liquids in treating hospitalized adult patients with dysphagia. Journal of Hospital Mediccine, 14(5),
Marik, PE., & Kaplan, D (2003) Aspiration pneumonia and dysphagia in the elderly. Chest 124:1,
McCurtin, A., Healy, C., Kelly, L., Murphy, F., Ryan, J., Walsh, J. (2018). Plugging the pateint evidence gap: what patients with swallowing disorders post-stroke say about thickened liquids. International Journal of Language & Communicaiton Disorders, 53(1),
Rowat, A., Graham, C., & Dennis, M. (2012). Dehydration in hospital-admitted stroke patients: detection, frequency, and association. Stroke, 43(3), Retrieved from doi: /STROKEAHA

27. Steele, C. M. , Alsanei, W. A. , Ayanikalath, S. , Barbon, C. E
Steele, C. M., Alsanei, W. A., Ayanikalath, S., Barbon, C. E., Chen, J., Cichero, J. A., Wang, H. (2015). The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia, 30(1), Retrieved from doi: /s x
Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging, 7, Retrieved from doi: /CIA.S23404
Swan, K., Speyer, R., Heijnen, B. J., Wagg, B., & Cordier, R. (2015). Living with oropharyngeal dysphagia: effects of bolus modification on health-related quality of life–a systematic review. Qual Life Res, 24(10), Retrieved from doi: /s y
Vigano, C., Silva, P., Cremonezi, J., Vannucchi, P., Guilhereme, C. (2011). Variation in the energy and macronutrient contents of texture modified hospital diets. Revista Chilena de Nutricion, 38(4),
Wittbrodt, M. T., & Millard-Stafford, M. (2018). Dehydration Impairs Cognitive Performance: A Meta-analysis. Med Sci Sports Exerc, 50(11), Retrieved from doi: /MSS
Wright, L., Cotter, D., Hickson, M., & Frost, G. (2005). Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet, 18(3), Retrieved from doi: /j X x