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


  1. 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.
  2. 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.
  3. Design effective treatment plans for clients with respiratory and GI disease processes including COPD, respiratory failure, and GERD.
  4. Prepare your diagnostic tool box to include cough testing, water screenings, pulse oximetry, respiratory muscle strength testing, and other evidence-based tools.
  5. Develop successful treatment plans by identifying reflux disease and its impact on swallowing function in your clients.
  6. 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.


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
  • 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


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

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


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


  • 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


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


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

Copyright : 07/26/2019

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


  1. Review the components to various tracheostomy tubes available and their functions
  2. Discuss the decision making process for placement of a tracheostomy tube and the advantages/disadvantages to short- and long-term placement
  3. Review basic daily nursing cares necessary for maintaining a tracheostomy
  4. Explain the assessment, safety precautions, and utilization of speaking valves
  5. 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
  6. Develop a plan of care and establish professional responsibilities across a multidisciplinary team to manage safe swallowing and maintain verbal communication



  • Definition of terminology used
  • Surgical vs. Percutaneous Tracheostomy


  • Endotracheal tube advantages/disadvantages
  • Tracheostomy tube advantages/disadvantages




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


  • 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



  • 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


  • 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

Copyright : 06/09/2018