[Dysphagia] conundrum re:estim

[Tara.Moore at chw.edu (Moore, Tara - SJHMC)]

When approached with inquiries regarding these controversial therapeutic
interventions, I feel it is our roles as SLPs to educate and to teach
advocacy skills. For example, we currently do not use electrical stimulation
to treat swallowing at our facility, however, if a patient or a patient's
family member has questions re: the approach, I pull a file to share
pros/cons, including ASHA's stance on the approach and lack of efficacious
data. I feel it is my duty to explain how the approach is claimed to work
and refer patients to other facilities in the area who may use the approach
to research it further. I provide my personal experience with the approach,
provide data for why we may or may not use the approach, and encourage the
patient to explore the alternate option with some guidance. This way you
steer clear from making disparaging remarks and teach self-advocacy at the
same time! 

Tara C. Moore, MS, CCC-SLP
Speech/Language Pathologist
Outpatient Rehabilitation
St. Joseph's Hospital and Medical Center (SJHMC)
602-406-6494

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Suzanne Morris
Sent: Wednesday, July 05, 2006 11:42 AM
To: CASK51454@aol.com; dysphagia@b9.com
Subject: Re: [Dysphagia] conundrum re:estim


I think that the "conundrum" lies in how we evaluate patients for the  
appropriateness of an unproven approach and how we set our own  
professional criteria for whether an approach works for that specific  
patient.   Each of us clearly prefers that what we do in therapy have  
strong efficacy behind it.  But the bottom line is that in no  
professional endeavor (including medicine) is each part of a  
potential treatment approach clearly proven to work.   I think that  
this is where our own honesty and professional skills come in.    
There are many things that unquestionably work for specific patients,  
whether we are talking about V-Stim, craniosacral therapy,  
therapeutic touch, oral-motor treatment etc.   If we choose to bring  
some of these approaches into our therapy, can we be honest with  
ourselves, our agencies and our clients in saying that we wish to  
explore this approach because we know it has helped other clients  
with whom we've worked?  Can we set up logical criteria for selecting  
patients who will receive the treatment?  Can we be honest enough to  
stop treatment when it is clear that it is not working for this  
particular client?  It is through exploration and fine-tuning by good  
clinicians that we learn enough about client groups, ways of  
administering a treatment approach etc. to define the basic  
parameters that would define a strong research study.   Our problems  
come when we don't know whether any studies have been done on a  
particular approach; when we lead patients and their families to  
believe that the approach we are using will quickly solve all of  
their problems; and when we don't stop to fine-tune or discontinue a  
treatment when patient progress does not meet a very broad set of  
criteria for individual patient safety and progress.

Suzanne

__________________________________
Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com


On Jul 5, 2006, at 1:30 PM, CASK51454@aol.com wrote:

>
> In a message dated 7/5/2006 12:22:23 P.M. Central Daylight Time,
> mbuckie@dmc.org writes:
>
> This may  not be a perfect analogy, but with some of the more  
> controversial
> and/or  extremely popular approaches within rehab (such as cranial  
> sacral
> therapy,  therapeutic touch) it seems like if you want to be  
> competitive in the
> consumer  market, you feel pressure  to offer these things that  
> people are asking
>  for, even though it may be a passing fad.
>
>
>
> Absolutely.  And if you tell pts that it is not a proven  approach  
> it sounds
> like you're making disparaging comments about these  other well- 
> respected
> facilities and their therapists.  Of course, the other  slp's swear  
> by it and say
> it's fabulous!
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
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