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[Dysphagia] Re: Dysphagia Digest, Vol 32, Issue 6 (Out of Office)


  • Subject: [Dysphagia] Re: Dysphagia Digest, Vol 32, Issue 6 (Out of Office)
  • From: hbrake at stvincents.com.au (Helen Brake)
  • Date: Thu Jul 6 12:06:35 2006

Helen Brake is on leave from Friday 7th July 2006 until Monday 7th
August 2006.  For any urgent matters please contact Pauline Dooley on
8382 3372 or page 6401.  I will attend to all other matters on my
return.  

Kind regards

Helen

>>> dysphagia 07/07/06 04:03 >>>

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Today's Topics:

   1. RE: Re: Alternative food thickeners (malindam@samhealth.org)
   2. Re: conundrum re:estim  (Suzanne Morris)
   3. RE: conundrum re:estim (Moore, Tara - SJHMC)
   4. Aspiration of Thin Liquid and Aspiration (Michelle Stevens)
   5. RE: Re: Alternative food thickeners (Irene Campbell-Taylor)
   6. Alternative thickeners (Alexandra Mitchell)
   7. Oral care (Alexandra Mitchell)


----------------------------------------------------------------------

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Date: Wed, 5 Jul 2006 11:50:33 -0700
From: <malindam@samhealth.org>
Subject: RE: [Dysphagia] Re: Alternative food thickeners
To: <eripley@yahoo.com>
Cc: dysphagia@b9.com
Message-ID:
	<C911E068369E2D4DAFD65BACB801373F4FEDCA@SHSEXVS02.int.samhealth.net>
Content-Type: text/plain;	charset="iso-8859-1"

Irene, have you or anyone else on the listserve read an article in J
Rehabil Med 2006; 38: 201 - 203, SUCCESSFUL TREATMENT OF LONG-STANDING
POST-STROKE DYSPHAGIA WITH BOTULINUM TOXIN AND REHABILITATION, which
deals specifically with cricopharyngeal dysfunction?  Do any of you have
1) an opinion about the article and/or 2) experience with the procedure?

Thanks,

Malinda Moore, CCC-SLP
Speech-Language Pathologist
Albany General Hospital
541-812-4162




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------------------------------

Message: 2
Date: Wed, 5 Jul 2006 14:41:50 -0400
From: Suzanne Morris <sem@new-vis.com>
Subject: Re: [Dysphagia] conundrum re:estim 
To: CASK51454@aol.com, dysphagia@b9.com
Message-ID: <CECA7E4F-B631-410B-B263-F12A8E4E1506@new-vis.com>
Content-Type: text/plain; charset=US-ASCII; delsp=yes; format=flowed

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
> http://lists.b9.com/mailman/listinfo/dysphagia



------------------------------

Message: 3
Date: Wed, 5 Jul 2006 12:53:19 -0700
From: "Moore, Tara - SJHMC" <Tara.Moore@chw.edu>
Subject: RE: [Dysphagia] conundrum re:estim
To: "'dysphagia@b9.com'" <dysphagia@b9.com>
Message-ID:
	<68880C4E8006214EA79912C891DFB4500AF69ACA@aznv-msg-005.chw.edu>
Content-Type: text/plain; charset=iso-8859-1


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
> http://lists.b9.com/mailman/listinfo/dysphagia

_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia



------------------------------

Message: 4
Date: Thu, 06 Jul 2006 09:54:11 +1200
From: "Michelle Stevens" <Michelle.Stevens@huttvalleydhb.org.nz>
Subject: [Dysphagia] Aspiration of Thin Liquid and Aspiration
To: <dysphagia@b9.com>
Message-ID: <s4acdde3.059@GW.hvh.co.nz>
Content-Type: text/plain; charset=US-ASCII

In response to:

The point is that thin liquid aspiration by itself is not sufficient to

cause pneumonia.  There are plenty of patients who aspirate thin 
liquids who have no negative consequences.    See Langmore et al. 
(1998) Predictors of Aspiration Pneumonia: How Important Is 
Dysphagia?Dysphagia 13:69***81 plus any number of references from the 
pulmonary literature, especially Paul Marik

Has this research been done on infants as well?

Michelle Stevens
Child Development Team Coordinator
Speech-Language Therapist - Paediatric Feeding
Hutt Valley District Health Board

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------------------------------

Message: 5
Date: Wed, 5 Jul 2006 17:52:55 -0700 (PDT)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: RE: [Dysphagia] Re: Alternative food thickeners
To: malindam@samhealth.org
Cc: dysphagia@b9.com
Message-ID: <20060706005255.25258.qmail@web30202.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

This is a case report of two patients only and must be regarded in this
context. I am not satisfied that the patients decribed actually had
cricopharyngeal achalasia - a very difficult thing to prove and
dependent laregley on a full medical history.

malindam@samhealth.org wrote:  Irene, have you or anyone else on the
listserve read an article in J Rehabil Med 2006; 38: 201 - 203,
SUCCESSFUL TREATMENT OF LONG-STANDING POST-STROKE DYSPHAGIA WITH
BOTULINUM TOXIN AND REHABILITATION, which deals specifically with
cricopharyngeal dysfunction? Do any of you have 1) an opinion about the
article and/or 2) experience with the procedure?

Thanks,

Malinda Moore, CCC-SLP
Speech-Language Pathologist
Albany General Hospital
541-812-4162




Confidentiality Notice: This e-mail message, including any attachments,
is
for the sole use of the intended recipient(s) and may contain
confidential
and privileged information. Any unauthorized review, use, disclosure or
distribution is prohibited. If you are not the intended recipient,
please
contact the sender by reply e-mail and destroy all copies of the
original
message.



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com

------------------------------

Message: 6
Date: Thu, 6 Jul 2006 18:48:37 +1000 (EST)
From: Alexandra Mitchell <pawprint1980@yahoo.com.au>
Subject: [Dysphagia] Alternative thickeners
To: Dysphagia@b9.com
Message-ID: <20060706084837.62273.qmail@web35507.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

In regards to the efficacy of thickeners, would it therefore be useful
to get the dietitian involved whenever a patient is put on thickened
fluids for swallowing safety? Or would it be necessary to simply
recommend to the medical team that the patient be put on IV fluids?
   
  What would be the alternative to recommending the thickened fluids?
Swallowing techniques are not considered effective if they are not
'proven' on VFSS.
   
  Kind regards,
   
  Alex

 		
---------------------------------
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------------------------------

Message: 7
Date: Thu, 6 Jul 2006 19:03:54 +1000 (EST)
From: Alexandra Mitchell <pawprint1980@yahoo.com.au>
Subject: [Dysphagia] Oral care
To: dysphagia@b9.com
Message-ID: <20060706090354.23539.qmail@web35511.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

Dear list,
   
  3 questions:
  I would like to inquire re: recommended oral care agents and practices
in other hospitals. The hospital in which I work uses the
lemon-glycerine swabs for oral care. It is my understanding that the use
of these only serves to dehydrate (absorbing water) further and results
in reflex exhaustion (Warner, 1986).
   
  Weitz et. al (1992) recommend the use of chlorohexidine mouthwash. Is
this the same as chlorohexidine gluconate gel/mouthwash/spray?
  What is recommended as best practice for oral hygiene practices?
   
  What is used in place of toothbrushing, if the patient is unable to,
or refuses to, open his/her mouth?
   
  Thank you so much in advance,
   
  Alex

 		
---------------------------------
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------------------------------

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