[Dysphagia] Qualifications

[dmhignight at comcast.net (dmhignight@comcast.net)]

My thoughts exactly!!
-------------- Original message -------------- 
From: "TERRY W. BAGGS" <TBAGGS@astate.edu> 

> Irene 
> 
> I have learned a few things from you through the years. Thanks for the 
> information you diligently provide. However, I have grown weary of the attitude 
> that pervades a number of your posts. I think I must be at my limit. 
> 
> I'm surprised you "stopped teaching SLPs" because their training was so 
> inadequate, but you apparently still teach OTs, nurses, dietitians, and others. 
> I don't see their training as being far superior to ours, in fact in some ways, 
> it is inferior. I think our universities do a good job of training SLPs for the 
> world in which they work. We (I teach in a university) could do better. But, 
> you must understand that our scope of practice is much broader than what you 
> probably think it is. And, we must train in ALL of these areas. How much do 
> you know about voice disorders or fluency disorders or audiological disorders, 
> etc.? And, I can tell you in most parts of the country, if the SLPs weren't 
> doing dysphagia management, no one would be. 
> 
> I think the proof is in the pudding. And, I don't believe that SLPs do a bad 
> job. I believe there are good rehab indicators that suggest otherwise. 
> 
> Terry Baggs 
> 
> 
> 
> 
> 
> 
> 
> 
> -----Original Message----- 
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf Of 
> Irene Campbell-Taylor 
> Sent: Monday, March 06, 2006 5:20 PM 
> To: Buckie,Marcia; Barbara C. Sonies; dysphagia@b9.com 
> Subject: RE: [Dysphagia] Qualifications 
> 
> I have provided direct, hands on patient care in major teaching hospitals as 
> well as nursing homes and community clinics for over 25 years. I don't imagine 
> you know many clinical neuroscientists as there are only about six of us in 
> North America. I have taught clinical as well as instrumental assessment to 
> physicians, SLPs, OTs, nurses, dietitians and others for many years as several 
> members of this list can attest. I stopped teaching SLPs at the university level 
> several years ago since the level and amount of training is so inadequate. 
> 
> "Buckie,Marcia" wrote: 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 
> > Date: Mon, 6 Mar 2006 10:21:46 -0800 (PST) 
> > To: 
> > 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, 81­88. 
> > 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 ³assist² in diagnosis ­ they 
> > never ³diagnose² by themselves. The most important part of any diagnosis is 
> > the patient¹s 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 individual¹s behavior, medical history, and medical status; 
> > *** While there can be no ³symptoms² of a symptom (dysphagia) it is correct 
> > that the patient¹s 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 
> > patient¹s 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 individual¹s 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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> 
> 
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> 
> Dr I Campbell-Taylor 
> Clinical Neuroscientist 
> Exclusive Distributor: 
> www.interactivetherapy.com 
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