[Dysphagia] Re: Dysphagia Digest, Vol 28, Issue 6

[chcky619 at bellsouth.net (chcky619@bellsouth.net)]

  Thanks as always Irene.  I am feeling pretty shabby, but working on it. 
Patti
  ----- Original Message ----- 
  From: <dysphagia-request@b9.com>
  To: <dysphagia@b9.com>
  Sent: Monday, March 06, 2006 2:01 PM
  Subject: Dysphagia Digest, Vol 28, Issue 6


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  > Today's Topics:
  >
  >   1. Qualifications (Irene Campbell-Taylor)
  >
  >
  > ----------------------------------------------------------------------
  >
  > Message: 1
  > Date: Mon, 6 Mar 2006 10:21:46 -0800 (PST)
  > From: Irene Campbell-Taylor <eripley@yahoo.com>
  > Subject: [Dysphagia] Qualifications
  > To: dysphagia@b9.com
  > Message-ID: <20060306182146.45894.qmail@web30201.mail.mud.yahoo.com>
  > Content-Type: text/plain; charset=iso-8859-1
  >
  >
  >  Recently, I have had a number of personal messages about my own 
background and training as well as requests for suggestions as to a method 
for upgrading skills and knowledge. I will answer these questions here.
  >  The ASHA position paper is my basis and excerpts serve to illustrate my 
points:
  >   'American Speech-Language-Hearing Association. (2002). Knowledge and 
skills needed by speech-language pathologists providing services to 
individuals with swallowing and/or feeding disorders. ASHA Supplement 22, 
81-88.
  >  Recognizing the significant potential impact of swallowing and feeding 
disorders on overall health and quality of life, it  is essential that 
speech-language pathologists possess the knowledge and skills to be 
proficient in their management of these disorders.
  >  Basic Competencies
  >  The purpose of this document is to outline the knowledge and skills 
needed by speech-language
  >  pathologists providing services to individuals with swallowing and/or 
feeding disorders. These knowledge
  >  and skill areas form the basis for assessing clinical competency in 
this specialized area of practice. '
  >  *** These are BASIC skills and knowledge - please note, not ADVANCED.
  >  In addition, speech-language pathologists assessing individuals with 
potential swallowing and/or feeding disorders and providing treatment to 
individuals with such disorders should have a basic understanding of the 
following:
  >
  >  . Normal and abnormal anatomy and physiology related to swallowing 
function.
  >  *** This implies a knowledge of basic gross anatomy, physiology, 
neuroanatomy, neurophysiology, pulmonary function, gastroesophageal 
function, and on and on.
  >  Please remember, these are described as being  BASIC competencies.
  >
  >  . Indications for, and procedures involved with, instrumental 
techniques used to assist in diagnosis and management.
  >  *** Please note that instrumental techniques "assist" in diagnosis - 
they never "diagnose" by themselves. The most important part of any 
diagnosis is the patient's history, followed by examination and THEN 
appropriate instrumental  examinations. VFSS is not always either 
appropriate or necessary.
  >
  >  . Understanding of medical issues related to swallowing and feeding 
disorders.
  >  *** Probably the most important aspect of all. Without a background in 
basic sciences and medical, clinical
  >  aspects or a very intensive learning process, this is not possible.
  >
  >  1.c. Knowledge of nutritional intake methods (oral and nonoral) and the 
problems associated with each that may contribute to dysphagia or be 
exacerbated by dysphagia;
  >  *** The major problems associated with, for example, NG and PEG 
feeding.
  >
  >  .d. Knowledge of signs and symptoms of swallowing and/or feeding 
disorders in the individual's behavior, medical history, and medical status;
  >  *** While there can be no "symptoms" of a symptom (dysphagia) it is 
correct that the patient's history and current medical status must be 
understood.  This means understanding the effects of GI, cardiopulmonary, 
immune, oncological, and many other disorders as well as the exact nature of 
the patient's nutrition/hydration status.
  >
  >  1.f. Knowledge of assessment strategies for use with individuals with 
swallowing and/or feeding disorders.
  >  *** I would suggest knowledge of a full and complete clinical 
examination including cranial nerves, extraocular movements etc.
  >
  >  Skills:
  >  1.1 Recognize signs and symptoms of swallowing and feeding disorders;
  >  *** Such as certain extraocular movements mentioned above as well as 
voice, respiratory abnormalities, gait etc. etc.
  >  .
  >  2.0 Role: Conduct a clinical examination of the upper aerodigestive 
tract.
  >  *** See above.
  >
  >  2.f. Knowledge of any special medical condition (e.g., pulmonary 
dysfunction, tracheostomy,
  >  neuromotor involvement) that may have an impact on an individual's 
feeding and swallowing.
  >  *** See above.
  >  Skills:
  >  2.1 Identify abnormal structure;
  >  *** How many look inside the mouth and inspect the roof of the mouth as 
well as dentition?
  >
  >  2.3 Identify significant signs, symptoms,medical conditions, and 
medications pertinent
  >  to dysphagia;
  >  ** This alone requires extensive study.
  >
  >  2.4 Conduct an oral, pharyngeal, laryngeal,and respiratory 
function/expiration examination as it relates to functional assessment of 
swallowing and feeding;
  >  *** It is difficult to know exactly what this means. Everyone should be 
able to perform an auscultatory examination of the lungs but is that what is 
meant?
  >
  >  3.b. Knowledge of the variability of normal swallowing behaviors (e.g., 
bolus volume,viscosity, age, or gender);
  >  *** How many are taught that there are gender differences? Age 
differences - in NORMAL swallowing?
  >
  >  One could go on ad nauseam but I think the problems are clear.
  >  Now the solution, and few are going to like what I have to say, but 
then, what else is new?
  >  This is a field that should be a post graduate area of study all by 
itself leading to a PhD in a specific area - pediatric, geriatric, brain 
injury and so on. There is no other way to ensure possession of the skills 
and knowledge that ASHA takes the position that everyone needs to have.
  >  If anyone else can suggest an equally comprehensive process, I would 
like to hear it.
  >
  >
  > Dr I Campbell-Taylor
  > Clinical Neuroscientist
  > Exclusive Distributor:
  > www.interactivetherapy.com
  >
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  > End of Dysphagia Digest, Vol 28, Issue 6
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