Ringing in 2016



2015 was an amazing year for me at Dysphagia Ramblings!  Amazing usually equals busy for me, but I really wouldn’t have it any other way!

I enjoy sharing ideas and newly learned information.  A huge thank you to ALL of you that support this blog and everything I do.  You are the reason that I get to share what I love!

As I said, this year was crazy!!  My friend Yvette McCoy and I started the year preparing a presentation to submit for the 2015 ASHA convention.  Although our talk unfortunately wasn’t accepted by the ASHA committee, it was picked up by Northern Speech Services and made into a webinar.  Through blood, sweat and tears, well, not literally, but some days it felt that way, we were able to create our webinar and it went live shortly after the 2015 ASHA convention!  You can find the webinar here.

I also joined with Tactus Therapy to create a new app called Dysphagia Therapy.   Yvette McCoy, Rinki Desai and I worked for months with the Tactus team to not only provide relevant and correct information for treatment and assessment of dysphagia.  After several months of back and forth ideas on the design, content and references, Dysphagia Therapy was released in October!!  We were ecstatic to have a very successful launch of our app that was born of a thirst for information at your fingertips.

September brought about a new course by Ianessa Humbert and Emily Plowman called Critical Thinking in Dysphagia Management.  I was honored and excited to be able to attend their inaugural course!!  The course was great as I expected it to be.  Great news!!  They are planning another Critical Thinking course coming in March in Gainesville, FL.   If you are considering going, you can read my posts on the course: Day 1, Day 2 and a link to the ChirpStory of all of my live tweets during the course.

October brought about another opportunity for me to present a webinar for SpeechPathology.com on using technology in dysphagia management.  It was exciting to be able to present my third course and to have enough of a voice to make it through the entire presentation!!

The ASHA convention was also an exciting time for me!  Not only did I have the opportunity to go to some excellent courses, work in the exhibit hall but also the opportunity to spend time with my friends.  Some were friends that I have spoken with online for years and never met face-to-face and some were friends I just hadn’t seen for a year or longer!  It’s always so much fun to spend quality time with others that understand me and what I do!  I tweeted throughout the entire convention and am planning on creating ChirpStory with those Tweets.  A link will be soon available!

To top of the ASHA convention, this year marked my 5th anniversary of blogging!!!  To celebrate I was hoping to have a few give-aways, but the response to my request for give-aways blew me away!!!  I was able to raffle off items from TheraSip, ISO-SED, Eric Blicker, Northern Speech Services, Medbridge, SpeechPathology.com, CIAO Seminars, Melanie Potock, Ampcare, SmartyEars and Tactus Therapy!  I couldn’t do what I do without so much support.  It means so much to me to have the support that I do!

To end the year on a positive note, I was able to team up with SmartyEars and my friend Barbara Fernandes to create iScreen Aphasia.  An app to screen patients with aphasia or language deficits.  I love that I was able to work with Barbara to create this app because I have used a similar paper version for some time.  During my internship, the SLP team sat down over several weeks to create the paper version, taking portions of standardized assessments to create a test that best fit their purposes.  This app is loosely based on that paper version, but created to fit a screening process for aphasic patients when a.)  there is no time for a standardized assessment, b.) standardized assessment is not available or c.) you want to track progress and use a measure for tracking purposes.

To begin the new year, I am giving away a code for iScreen Aphasia (available for the iPad).  The winner of the app is Danielle Knowlton!!  Congratulations and I look forward to more give-aways in the coming year!!

I hope everyone has the best year ever and can make the most of their 2016!


First, I would like to thank the MannaQure team for donating a copy of the MannaQure assessment for review on Dysphagia Ramblings!

The MannaQure assessment is a comprehensive, norm-referenced English to Spanish assessment of dysphagia and dysarthria.  The test was normed using 145 participants 21 years and older with with 95 of the participants speaking English as a second language.  Participants had a wide variety of neurological diagnoses.

The MannaQure is scored by sections.  Each section is then totaled and divided by the number of assessments in the section.  The percentage can then be interpreted as WFL, mild, moderate, severe or profound.

Test items needed include:

  • tongue depressor
  • pen light
  • stopwatch
  • cold, wet cloth
  • iced spoon
  • lemon, peppermint or vanilla extract
  • gloves
  • straw
  • teaspoon
  • cup
  • trial texture consistencies
  • trial liquid consistencies

The sections assessed in this test include:

  • Receptive Language
  • Expressive Language/Speech Production
  • Cognition
  • Oral Mechanism Function (Labial Structure, Lingual Structure, Laryngeal, Soft Palate, Respiration)
  • Bedside Evaluation (Oral Phase, Pharyngeal Phase)
  • Total Dysphagia/Dysarthria Degree of Severity
  • (For Profound Deficits only)-Oral-Facial Stimulability Probe and Bedside Evaluation Total.

The first section, Receptive Language is a series of yes/no questions related to orientation and directions for the patient to follow.

Expressive Language consists of orientation and automatic speech tasks.

The cognition section is a series of questions related to orientation and general information such as a summer month.

The Oral Mechanism Function is a basic oral motor assessment, smile, pucker your lips, stick out your tongue.  Each task also includes information about which cranial nerve is involved.  The Laryngeal section includes:  dry swallow, cough, clear throat, humming, increasing volume while counting to 5.

Oral-facial stimulability involves response to:

  • cold wet cloth on facial structures
  • iced spoon response on lip
  • response to smell
  • swallow elicitation with laryngeal massage
  • response to touch on the facial structures
  • eye tracking
  • presence of a gag reflex

The pros of this test:

  • It is very quick and easy to administer.
  • All instructions are translated to Spanish with a pronunciation guide.
  • Cranial nerves are involved (they are near and dear to my heart)!
  • It is very comprehensive.
  • It is portable and easy to carry.  You really only need to protocol.


The cons of this test:

  • The pharyngeal phase is assessed, however this phase is nearly impossible to assess without instrumentation.
  • Signs/Symptoms of aspiration listed include watery eyes and runny nose.  There is no evidence to support this.  I also don’t know that I would place pocketing, fatigue or cognitive decline as a s/s aspiration.  They may be contributing factors to dysphagia/aspiration.

Overall the authors did a very nice job of putting together an easy to use assessment guide that gives a severity rating for your patient.

For more information on MannaQure visit their website here.




Restoring Dignity and Quality of Life at Mealtime-Guest Post

By Howard Rosenberg, Director of Dining Services at Amsterdam Nursing Home

Howard Rosenberg is the Director of Dining Services at Amsterdam Nursing Home, a 409-bed long-term care residence in New York City.

It’s no secret that adults with dysphagia are at higher risk of malnutrition and dehydration than most healthy adults. Transitioning from “regular” meals to thickened and pureed food is hard and met with resistance. Yet, overcoming the challenge is essential to both the individual and his or her caregivers.

After experiencing so many mealtime issues, my staff conducted an eight-week study of 16 residents with dysphagia. We observed that residents tried to open packages rather than wait for assistance, drank thin beverages before they were thickened, or refused them altogether after watching them be thickened.

Change was necessary – but it didn’t have to be drastic to make a difference. Our staff knew we needed to:

  • Increase fluid intake of residents with swallowing difficulties
  • Restore resident dignity, quality of life and desire to enjoy mealtime
  • Re-establish a personal level of independence during meal service

In order to do so, we made the following changes, which can easily be adopted in the home setting as well:

  • Thickening residents’ beverages before serving them, using a stable pre-thickened water or juice– available at many pharmacies (ask your pharmacist) – as the base of each recipe, which eliminates the need to thicken liquids in front of the residents.
  • Pouring all beverages below the top of the cup, e.g. 4 oz. of juice in a 7 oz. cup, to reduce spilling caused by shaky hands, thereby boosting residents’ confidence in serving themselves.
  • Serving pre-thickened ready to eat soups and a variety of flavored broths prepared with a pre-thickened water.

We also offered a variety of pre-thickened beverage flavors throughout the day – served with snacks, at the bedside and when taking medications.

After these adjustments, we’ve found that fewer seniors have requested help during each meal, and that residents’ fluid intake has increased significantly.

The key to our successful hydration program at Amsterdam Nursing Home has been using a pre thickened crystal clear unflavored nectar or honey water (in our case we use Thick-It® AquaCare H2O®). This product is the primary base for all the flavorful drinks and soups we serve our residents. We are also able to fulfill specific beverage requests, hot or cold, including ice cubes with this product. Using pre-thickened waters means no mixing or measuring thickeners, which we believe has a direct impact on the appeal of the drink, the independence it gives the resident to serve themselves, and subsequent consumption.

The program, although requiring some additional staff time for mixing the beverages, has actually saved us money due to the reduced waste per resident.

Residents have given positive feedback on the program – through their comments and overall moods – and are more engaged during mealtime.

Whether you’re a long-term care employee, a speech-language pathologist or caring for someone with dysphagia at home, these small changes can make mealtime a safer and more enjoyable experience for your patients or loved ones.

Give Away


I am very grateful for the VERY generous donations to give-away to celebrate 5 years of blogging!!

So, how exactly is this going to work?  

My blog all started with the ASHA convention 2010, so that’s where 5 years will start!!  Throughout the convention November 12-14, 2015 I will be posting on Facebook and Twitter.  This will ONLY happen on the Dysphagia Ramblings page, so make sure you like the page.  The posts will also appear on Dysphagia Ramblings Twitter.  Answer each post for a chance to win!  

The prize will be announced with each post.  Names will be raffled randomly and each person will have one chance for each prize!  

The list of prizes you ask?

  • Internal Branch Superior Laryngeal Nerve Course from Dr. Eric Blicker
  • ISO-SED device 
  • TheraSip Swallowing Trainer
  • CTAR Ball from TheraSip
  • Tongue Press from TheraSip
  • TheraMist from TheraSip
  • A TheraPACK from TheraSip (All 4 of the above!!!)
  • A One Year Subscription to Speech Pathology.com
  • A One Year Subscription to MedBridge
  • $100 Voucher to any live course from CIAO Seminars
  • Codes to the new app from Tactus Therapy:  Dysphagia Therapy
  • Codes to Dysphagia2Go from SmartyEars
  • Book from Northern Speech Services
  • Online Course from Northern Speech Services

WOW!!!  I am beyond excited!!!  How about you??

Make sure to LIKE the Dysphagia Ramblings Facebook page and follow @dysphagiarmblng on Twitter to enter to win these AMAZING prizes!!!

ASHA 2015 and Blog Give-Aways Just Around the Corner!

IMG_4471 IMG_4472

It’s that time of the year, the leaves are turning and falling, it’s still dark when my alarm goes off and my phone is reminding me that my flight to Denver is in 20 days!!!  

Every year is the same anticipation.  Social media starts flaring up with talk of the upcoming ASHA convention and I start counting down the days until I see my friends again.  This year is no exception!!

What is different for me this year though is my Blogiversary.  Five years ago, during the ASHA convention, I started blogging and became active on social media.  I have made so many new friends since that time!!  

In honor of FIVE years of blogging I’m having some amazing give-aways!!!  I am extremely humbled and honored by the generosity of donations for this give-away!!!  Keep watching for more details coming in the next week on the specifics of the give-away!!  Some of the items:

  • ISO-SED Device
  • TheraSip Goodies
  • Northern Speech Services Goodies
  • Internal Branch Superior Laryngeal Nerve course from Dr. Blicker at CEU Allied Health
  • $100 voucher for a live course from CIAO Seminars
  • Free codes for a new, exciting dysphagia app
  • Free code for Dysphagia2Go
  • EMST 150
  • More in the works!!

ASHA week will be a busy and FULL week with friends, colleagues, sessions, exhibits and give-aways, not to mention blogging!!!  As always, I will be live-tweeting courses I attend.  

What courses will I be attending this year?

Wednesday Night will be the Meet the Master’s Program:  Radiological Procedures, Evaluating the Upper and Lower Digestive Systems from Infancy to Senescence.

Thursday’s Lineup:

  • #1040 What’s Wrong with My Patient? Esophageal Disorders and the Effects of Human Aging on Swallowing-James Coyle
  • #1125 Best Practices in Head and Neck Cancer:  Implementing Speech Pathology Pathways in the Multidisciplinary Team-Messing, Hutcheson, Blair
  • #1177 Dysphagia Therapy:  Are There Guidelines in Prescribing Exercise-Based Treatments?-Ruzicka and Doyle
  • #1214 Skill vs. Strength Training in the Management of Dysphagia:  The Great Debate-McCoy, Humbert, Plowman

Friday’s Lineup:

  • #1341 Neuroplasticity & Dysphagia Rehabilitation:  How to Connect the Dots-Martin and Malandraki
  • #1382 Intervention Planning for Dysphagia Based on Objective Studies and Reports:  Translating Results into Practice-Salmon and Maharay
  • #1473 Can We Use “Compensatory Strategies” to Challenge Swallowing Impairments?-Humbert, Vose, Sunday
  • #1519 Gauging the Aging Swallowing:  Clinical Considerations for the Speech-Language Patholgoist-Rinki and Yvette
  • #5639 Comparing Swallowing Efficiency by Gender, Bolus Consistency and Task-Palmer, Bolognone, Harrington, Graville


  • #1641 Rehabilitative Training Using Exercise: Blending Muscle Conditioning and Motor Learning Aspects into Therapy-Carnaby, Ruddy, Crary
  • #1688 Strengthening Swallowing and/or Dysphagia Intervention:  Three Mythbusters!-Robbins, Rogus-Pulia, Rusche
  • #1782 Complex Dysphagia Cases in the Adult Acute Care Setting-Kizner, Deane, Kutch
  • #1828 Efficacy of Adjunctive Modalities in Dysphagia Treatment-Lazaras, Troche, Langmore

Now it’s time to make my packing list!  

  • Comfy clothes (I’m not presenting and have no intention of dressing up!  Long sessions and much learning calls for comfort!)
  • Comfy shoes (There’s A LOT of walking!)
  • Light bag (To carry my iPad and chargers.  Nothing heavy because it is a long day!)
  • Hygiene supplies (Shampoo, soap, the works.  Don’t forget the deodorant…..long days!!)
  • Sweater or light jacket (Some rooms are hot and some rooms are cold.)
  • My list of sessions.  (There is nothing worse than arriving at the conference and having no clue where to go.  There are computers to  create and print your agenda, however they can be very crowded.)
  • Portable charger (I use a New Trent which will charge my phone and iPad fully at least once if not more.)
  • Power strip or multi USB charger.  (Let’s face it, hotels often don’t have enough outlets for all your electronics and if you have a roommate or 3, you will definitely need the extra charging space.  
  • A small first-aid kit.  (You never know when a headache will come on or you need a band aid for blisters from SO MUCH walking!)
  • An open mind.  (There are so many sessions to attend and so much information to learn!!  Be ready to learn, not only in your sessions but in the exhibit hall.)
  • Pajamas (There is very little time to sleep, however it’s nice to be comfy during those brief periods of rest!)

I hope to see you in Denver!

Day 2 Critical Thinking in Dysphagia Management

What drives your assessment and therapy plans?  

Thank about this.

Are you that person that is in and out in 15 minutes, quick chart check to look at diagnosis, quick med check, look at oral structures and range, trial some food and done?

What about your therapy?  What does that look like?  Are you handing your patient a list of oral motor exercises to complete 10 times each?  Are you watching your patient eat in the dining room?  Are you hooking the patient up to E-Stim and letting them sit with the stim on their neck?

Are you an SLP that maybe thinks you’ve learned all you ever can about dysphagia?  

As a dysphagia specialist, you will NEVER learn everything about dysphagia.  There is always room to grow.  There is always a new course to attend.  There is always that person that is new to the field.  

Sometimes, I’m guilty of attending a course and thinking, yea, what exactly are you going to teach me?  

I went into this Critical Thinking course with high expectations and my expectations were met and exceeded.  This course was FABULOUS!!  It was thought-provoking and very relevant to everyday work. Dr. Humbert and Dr. Plowman are very entertaining and are great at involving participants.

If I had to sum up my experience with this course and tell everyone in one sentence what this course is about it would be this.  Investigate the why of the swallowing difficulties throughout the evaluation and treatment.  The why is the most important part.  If you can justify why there is a problem, you can determine the most appropriate treatment plan.  If you understand the why of your treatment plan, why you chose the techniques you chose and why the patient needs to work on each techinque, you can justify your therapy.  

There will soon be a chirp story created with the tweets from this workshop! 

The best news………..

This workshop will happen AGAIN!!  Keep an eye out for news!!!