[Dysphagia] Fwd: cough/apraxia format for mbs reports

[atsslp at yahoo.com (Alyce Schoenagel)]

Alyce Schoenagel <atsslp@yahoo.com> wrote:Date: Tue, 12 Oct 2004 18:08:37 -0700 (PDT)
From: Alyce Schoenagel 
Subject: cough/apraxia format for mbs reports
To: dysphgia@b9.com

wanted to respond to some requests from earlier threads..sorry, but I do not recall who asked for this information, but here goes!
 
spont vs volitional cough/airway protection/apraxia..I have found that in traditional apraxia treatment, many of the voicing drills lead to the Pt's ability to hold breath and eventually execute a volitional cough.  I don't believe I ever "taught" a cough directly, although I do some techniques that Irene spoke of as assisted/directed cough, w/o knowing it..time to pow wow with my RT on that subject!
 
MBS reports....I have the luxury of working in a small community hosp where I am the only SLP.  Our sister hosp also has 1 SLP.  All of my documentation is done on the computer. I can have MIS pulg in any form I develop, including check offs, blanks with a "lookup" so you can choose what you want, or do the entire thing "free" form, similar to a SOAP format.  Our standard bedside eval is on line, moslty with "look ups" and blank areas to fill in as we please, as is the Cog eval and note form for the SAR unit.  I do my video reports free hand, and include all the stuff you see on typical "check off" evals, but with much greater detail.  When I receive a video report from a Baltimore based hosp, it gives me little information to initiate a tx plan.  If there is premature spill, how much, to what level?  Enough to be a choking risk if it does not clear with mult swallows?  What about mult swallows..did they occur spont, could the Pt be cued, could they initate one at all?  "aspiration
 of thin liquids"...so what!  What was the bolus size/delivery method,
was it silent? Could they clear it with a volitional cough (there's that cough thing again!)?
Blah, Blah, Blah...I try to make the reports user friendly... we know how many of the Doc's acutally read them. It begins with a summary-highlighting the "important" items for the Dr...asp or not, oral vs non oral. I then go on to either a summary oral/pharyngeal phase, or do a blow by blow on each consistency tested. As mentioned in previous messages from therapists that receive these gems, compensatory strategies are not always done, as my population is 90% in patient-the kind of folks who can not do/use them enough to make a sig difference.  I take more time with the out patients, based upon age, cog, etiology etc. Besides, how often does a "chin tuck" acutally work??? Not too often in my neck of the woods, and rarely on neuro Pts.  The SLP at the sister hospital has her MBS reports done in "canned text"..she hits a button and an entire, generic report pops up...all she does is fill in a summary paragraph...different strokes....I am far too "detail oriented" (or should I be honest
 and say anal?) for that, and try to give the kind of information that I would want to receive.
 
Alyce Schoenagel
SLP-Harford Memorial Hosp, MD


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