[Dysphagia] Qualifications

[mbuckie at dmc.org (Buckie,Marcia)]

I agree with Barbara. With the exception of assessment of ocular movements and gait, I think graduate classes and clinical practicums are providing this. I have gotten training in lung auscultation, but considering that I work in an acute setting with critical care nurses and physicians, I don't do it routinely, because I know that there frequent assessments are going to be better than mine.

Irene, you make several good points, however, I have yet to run across any neuroscientists that do patient care, let alone dysphagia evaluations, and I work for an 8 hospital healthcare system. 

Marcia

Marcia Peterson Buckie, M.A.CCC-SLP
Senior Speech Language Pathologist
Physical Medicine & Rehabilitation/ 1 West
Sinai-Grace Hospital
Detroit, Mi 


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Barbara C. Sonies
Sent: Monday, March 06, 2006 4:38 PM
To: Irene Campbell-Taylor; dysphagia@b9.com
Subject: Re: [Dysphagia] Qualifications


I beg to differ with you Irene as many of the classes that are being taught
for masters level students in SLP do cover the skills listed below. I teach
both a basic and advanced level courses and feel that if my students retain
all that was presented in my class and have a strong practicum experience
they ARE indeed qualified!!.


> From: Irene Campbell-Taylor <eripley@yahoo.com>
> Date: Mon, 6 Mar 2006 10:21:46 -0800 (PST)
> To: <dysphagia@b9.com>
> Subject: [Dysphagia] Qualifications
> 
>  
>   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:
>    OEAmerican 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. OE
>   *** 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:
>    
>   EUR 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.
>    
>   EUR 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.
>    
>   EUR 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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