Full Course Description

Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

What’s the safest diet? Is he aspirating? Can she swallow these pills? He hates the pureed food – what else can we do? She’s refusing the thick liquids! Is he going to get pneumonia? Does he need a feeding tube?

These are issues that we face every day in our work with children and adults with dysphagia. How do we keep our clients safe, while making sure they’re well hydrated and well nourished, and normalize eating as much as possible?

Sometimes, it’s about more than just swallowing.

This course will examine the inter-relationships between respiration, gastrointestinal function, and swallowing to allow clinicians to better identify the underlying causes of their client’s swallowing difficulties. We’ll look at specific respiratory and GI diagnoses and their impact on what, when, how much, and how safely our clients eat. Using clinical case studies, we’ll examine the evidence to provide you with the tools you need to perform a thorough assessment and implement a comprehensive treatment plan that takes into account all of the potential contributing factors.

Program Information

Objectives

Use your understanding of the interrelationships between the respiratory and gastrointestinal systems to identify and treat the causes and not just the symptoms of dysphagia in your pediatric and adult clients.
Evaluate the impact of respiratory and gastrointestinal functions on swallowing systems in order to choose targeted interventions and increase your effectiveness in reducing aspiration risk.
Design effective treatment plans for clients with respiratory and GI disease processes including COPD, respiratory failure, and GERD.
Prepare your diagnostic tool box to include cough testing, water screenings, pulse oximetry, respiratory muscle strength testing, and other evidence-based tools.
Develop successful treatment plans by identifying reflux disease and its impact on swallowing function in your clients.
Design assessment strategies that allow you to identify those clients who are more likely or less likely to get sick as a result of aspiration.

Outline

RESPIRATORY SYSTEMS: Breathing/swallowing coordination

Overview of systems – anatomy/physiology
Breathing/Swallow coordination
Coordination and aspiration
Airway protective mechanisms
Reflexive cough

GASTROESOPHAGEAL SYSTEMS: The impact on feeding and swallowing

Esophageal function
Digestive functions
Reflux mechanisms
When does GER become GERD?
GERD signs and symptoms
GERD and feeding/swallowing difficulties
Esophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS: What’s the connection?

Pressure, energy, and innervation
Extra-esophageal reflux

ASPIRATION: How much is too much?

Pulmonary Clearance Mechanisms
Predictors of pneumonia in various populations

RESPIRATORY DISEASE PROCESSES: The impact on feeding/swallowing

Pediatric:
- Infant Respiratory Distress Syndrome (IRDS)
- Bronchopulmonary Dysplasia (BPD)
- Respiratory Synctial Virus (RSV)
- Congenital Heart defects
Adult:
- Obstructive Sleep Apnea (OSA) and dysphagia
- Congestive Heart Failure (CHF)
- Obstructive Conditions
- Restrictive Conditions

PNEUMONIAS: It’s not all aspiration

Pneumonia vs Pneumonitis
Community Acquired Pneumonia
Healthcare Acquired Pneumonia
Aspiration Pneumonia

AIRWAY MANAGEMENT: What’s the impact on swallowing?

Non-invasive positive pressure ventilation
High flow nasal cannula
Intubation
Tracheostomies

ASPIRATION ASSESSMENT: Clinical Assessment – Making the Most of your Bedside Eval

Cognitive assessment
Pitch elevation
Serial swallows
Oral mechanism
Respiratory factors
Cough
Respiratory muscle strength
3 oz water tests
Understanding lab values
Pulse Oximetry

Instrumental assessment – Which type and when?

Modified Barium Swallow studies
Fiberoptic Endoscopic Evaluation of Swallowing

ASPIRATION MANAGEMENT: Diet modifications – Not such a benign intervention

Implications of dietary changes
Compliance issues
Thick liquids – pros and cons
Water protocols

Strategies and Exercises – What does the evidence tell us?

Compensation
Sensory interventions
Principles of exercise physiology
Lingual strengthening
Pharyngeal strengthening
Expiratory muscle strength training

REFLUX ASSESSMENT: What do these tests tell me?

Upper GI studies
Ph Monitoring
Esophagoscopy
Scintigraphy

REFLUX MANAGEMENT: What’s the dysphagia clinician to do?

Lifestyle modifications
Positioning
Diet modifications
Medications
Effects of acid suppression
Surgical interventions
New directions in reflux management

Target Audience

Speech-Language Pathologists
Speech-Language Pathology Assistants
Occupational Therapists
Occupational Therapy Assistants
Respiratory Therapists
Nurses
Nursing Assistants
Restorative Nursing Staff
Dietitians
Dietary Managers
Long-Term Care Professionals

Copyright : 07/17/2020

Dysphagia and Medication Management – A Hard Pill to Swallow

Sometimes it’s hard to determine what’s causing swallowing difficulty in individuals with dysphagia. Does the swallowing difficulty make it harder to take medication or are the medications impacting their ability to swallow safely? Unfortunately, this confusion leads to frequent medication errors in these clients.

In this session, Angela Mansolillo, MA/CCC-SLP, BCS-S, Board-Certified Specialist in Swallowing Disorders, will teach you medication management in individuals with swallowing disorders. You will learn how pill swallowing impacts normal swallow physiology and identify alterations, and neurological changes, that occur in individuals with dysphagia. Medication formulations will be discussed and the legal implications of practices to facilitate administration, including crushing or thickening, will be reviewed.

You will finish this session with effective tools for improving safe medication administration, mitigating side effects that impact swallowing, and reducing medication errors in people with dysphagia.

Program Information

Objectives

Upon completion of this program, participants will be able to…

Determine three potential medication modifications for people with dysphagia and their consequences.
Analyze three common medication side effects that can impact swallow function.
Devise three strategies for improving swallow safety during medication administration.
Implement three strategies to reduce medication errors in individuals with dysphagia.

Outline

Pill/Tablet Swallow Physiology

What happens when we swallow a pill?

Issues in Administration for People with Swallowing Disorders

Medication type – liquids, tablets and capsules
Potential for medication errors
Altering medications – easier to swallow but is it really safer?

Medication Induced Dysphagia

Neurological impacts
GI impacts
Impact on salivation, dry mouth

Interventions

Compensations and maneuvers – making swallowing easier
Improving dry mouth
Sensory interventions
Reducing medication errors related to dysphagia
New directions – changes in formulations for easier swallowing

Target Audience

Speech-Language Pathologists
Registered Nurses

Copyright : 11/20/2020

Dysphagia: Targeted Interventions for Children & Adults

Clinicians often take a “more is better” approach to dysphagia intervention – long lists of exercises, strategies, and interventions that our clients and their families can’t possibly adhere to. This recording will help clinicians develop targeted interventions for children and adults with dysphagia. Case reviews will be utilized to assist participants in identification of physiological targets for swallow treatment including breathing/swallow discoordination, delays in swallow response, and pharyngeal dysmotility among others. Assistance with development of impairment-specific strategies, exercises and compensations will be provided.

Program Information

Objectives

Discuss the pros and cons of dietary modifications for clients with dysphagia
Identify compensatory swallowing strategies specific to physiological impairments
Design exercise programs that will target specific physiological impairments for clients with dysphagia

Outline

Intro – Why an impairment-based approach? Making the case for target interventions
Choosing dietary modifications -food texture, thick liquids
Managing the consequences of the interventions we choose
Choosing strategies for:

Breathing/swallow coordination
Swallow response delay
Reduced airway closure
Impaired pharyngeal motility

Exercises that target:

Breathing/swallow coordination
Reduced hyo-laryngeal excursion
Reduced airway closure
Impaired pharyngeal motility

Target Audience

Physical Therapists
Physical Therapist Assistants
Occupational Therapists
Occupational Therapy Assistants
Athletic Trainers
Speech Language Pathologists

Caring For Patients with Tracheostomy & Ventilator Dependency: A Practitioner’s Guide to Managing Communication and Swallowing

Develop a Comprehensive Management Plan for Adults Living with Acute & Long–Term Tracheostomy

As medical technology and intervention evolves, more patients are faced with temporary and long–term tracheostomy/ventilation as a part of their recovery. The very presence of a tracheostomy tube may elicit visceral reaction to secretion management and dehumanize the patient who is unable to exercise their decision making capacity, orally communicate their needs, and interact socially with staff or family.

Practitioners in acute hospitals, transitional rehabilitation units, skilled long–term settings, and homecare arenas are challenged to not only understand the basic functionality of a tracheostomy tube, but complete daily cares, assist their patients with swallowing and oral communication, and even train non-medical care providers. Management of the tracheostomized patient is often assumed to be complex. This misconception may become a barrier for placement in an environment most conducive to overall rehabilitation; to foster social closeness with staff, friends and family; and ultimately result in prolonging the weaning process.

This recording will outline and compare the basic components of a tracheostomy tube, decision making surrounding the most appropriate type of tube to use for various populations, and the risks/benefits of placement. Through review of daily cares, the assessment and placement of a speaking valve, and dysphagia characteristics for this population, you will build the skills and confidence necessary to develop a comprehensive management plan. Finish this recording with a solid foundation of general knowledge, critical thinking algorithms, and an understanding of the roles and responsibilities of their specialty when faced with tracheostomized patients.

Program Information

Objectives

Review the components to various tracheostomy tubes available and their functions
Discuss the decision making process for placement of a tracheostomy tube and the advantages/disadvantages to short- and long-term placement
Review basic daily nursing cares necessary for maintaining a tracheostomy
Explain the assessment, safety precautions, and utilization of speaking valves
Discuss assessment and treatment of swallowing and the application of a speaking valve to minimize aspiration risks and maximize oral communication including bedside screening vs. formal assessment
Develop a plan of care and establish professional responsibilities across a multidisciplinary team to manage safe swallowing and maintain verbal communication

Outline

ANATOMY AND PHYSIOLOGY OF TRACHEOSTOMY

Definition of terminology used
Surgical vs. Percutaneous Tracheostomy

CLINICAL FEATURES OF A TRACHEOSTOMY TUBE INTUBATION AND TRACHEOSTOMY - BENEFITS AND RISKS

Endotracheal tube advantages/disadvantages
Tracheostomy tube advantages/disadvantages

SIZING TRACHEOSTOMY TUBES

MANUFACTURERS OF TRACHEOSTOMY TUBES

SPECIAL CONSIDERATIONS OF MANAGING A TRACHEOSTOMY TUBE

Cuff pressures
Essential daily cares
- Necessary supplies
- Cannula cleaning/exchanging
- Maintaining stoma and skin integrity
Minimal Leak technique vs. minimal occlusive volume

SPEAKING VALVES

Anatomy & physiology of common speaking tubes
Population and timing
Warning/Precautions
Assessment and placement guidelines
Trouble shooting during valve assessment/use
Ventilator modifications for safety and success
Inline speaking valves
- Decision making for the respiratory therapists
- Tidal volumes
- Peak inspiratory pressures
- Minimal vent parameters to facilitate successful application

FENESTRATED TRACHEOSTOMY TUBES

DYSPHAGIA AND THE TRACHEOTOMIZED PATIENT

Post extubation consideration
Effect of tracheostomy on swallowing
Effect of cervical bracing on tracheotomized patient
Assessment of swallowing
- Blue Dye vs. Fees vs. MBSS
Impact of speaking valve upon swallowing

MULTIDISCIPLINARY CARE OF A PATIENT WITH TRACHEOSTOMY

Role of SLP, nurse, and respiratory therapist
Review a sample of policy/procedure

Target Audience

Speech-Language Pathologists
Speech-Language Pathology Assistants
Occupational Therapists
Certified Occupational Therapy Assistants
Nurse Managers
Nurses
Respiratory Therapists
Rehab Directors
Licensed Practical Nurses