For those of you who haven’t heard of the McNeill Dysphagia Therapy Program or MDTP, you need to look it up. You can Google search the supporting evidence of the program.
I have been extremely excited about this course since I’ve heard about it 3 years ago. The downfall, it’s only offered at certain times. The limitation of the course prevented me from attending for a while, however this January, I had the opportunity to attend in Orlando.
In 2010, I attended the ASHA convention in Philadelphia. I went to a session by Dr. Carnaby and Dr. Crary talking about MDTP. Of course, it was mostly discussing the research and success behind the technique. It was interesting though to see that the results they found with this therapeutic technique indicated superior outcomes to traditional therapy alone.
At first, I was a little uncertain why there was so much secret behind this therapy. When you go to the course, you have to sign a contract that you won’t teach the technique to anyone else. Also, to use this technique and call it MDTP, you must be certified. If the therapy is so great and successful, why not share it with everyone?? In talking to the researchers, Dr. Carnaby and Dr. Crary, they want to make sure that SLPs are properly trained in this technique before going out and attempting it with their patients. They want to train the SLPs in the technique.
The technique makes sense. In providing services for over 10 years, one thing has become very prevalent in our services. We have increased our understanding for neuroplasticity and exercise-based therapy programs. When we look at neuroplasticity, we must use specific tasks to increase the swallow. If I want a person to run a marathon, they have to run. Sitting on an exercise bike daily will not get them prepared for the marathon without actually practicing running. If I want my patient to be really good at sticking out their tongue, that’s what I’ll have them do. I want my patients to improve their swallowing, so that’s what I need to target with my patients.
MDTP is a systematic exercise based program, focusing on swallowing using exercise principles. While I am not allowed to teach the specifics, or include them in this post, the basics and concepts of this approach are freely available in the articles that can be accessed through Google.
We can learn a lot through our PT/OT counterparts. They work the muscle systems through exercise based therapy using weight and resistance to increase the motoric output of the muscular system. This is what we should be doing. While we can’t necessarily add weights to the swallowing muscles, we can use food and the bolus as resistance and weight. We have the effortful swallow available using a higher resistive swallow with our patients. sEMG can be utilized to get the patient to swallow harder and to monitor their swallows.
So many of us have learned therapy the old way. The stick out your tongue 10 times way. That’s how I learned. Naturally, there was little carry-over, little improvement and a lot of patients wondering what in the heck we were even doing.
I have had my first new patient since learning MDTP. This is an NPO patient with a feeding tube. Traditional therapy to increase the muscles of the swallow has not worked. Two MBSSs later, the patient is still NPO, with occasional ice chips and drinks of water. During our first session, the patient went through the first 4 levels of MDTP. NMES was introduced during the session, as patient had to swallow 5-6 times to clear the bolus. NMES combined with MDTP reduced the number of swallows per bolus to 1-2, occasionally 3.
MDTP finally focuses on swallowing as a whole. It gives us a protocol with a food hierarchy, a specific swallow, a program to follow and a pass/fail criteria. It forces us to look at the muscle function, how the muscles are made, what we can do to change the muscles, after all, we are rehabilitating our patients.
I highly recommend this course to anyone and everyone treating patients with dysphagia. The information regarding muscles, therapy and neuroplasticity is invaluable and great review if you are familiar with the content. The technique is phenomenal with no materials, tools or expensive equipment to buy. You can take the 1 day course and utilize it the next day.
In our therapy world where outcome based therapy is becoming essential for reimbursement, MDTP gives us a way to measure outcomes for our patients. More importantly, MDTP works. Not for everyone, unfortunately there are those we just can’t help. Our patients though deserve and expect the most recent, successful therapy processes we can provide. Our patients success is why we do what we do.