Training other professionals in Dysphagia

As a dysphagia therapist, I am often asked to train or inservice other professionals in dysphagia.  This usually includes inservices for nursing staff, CNA’s, dietary and at times, other therapists. 

I find that the best way to educate, is to let them “experience” dysphagia.  I will typically go over the basics of the swallow.  I will go over the oropharyngeal structures and their function in swallowing.  The lips help keep the food/drinks in the mouth, the tongue helps to move the food/drink around in the mouth and to push it back to the throat, the cheeks help keep food from pocketing between the gums and cheeks, the airway moves up and forward and the esophagus opens.  I find that if they understand that dysphagia involves more than just coughing with drinks or food.

I try to simulate dysphagia with my students.  I have been known to have them perform the Masako, put peanut butter on the floor of the mouth and have them keep their tongue in it then chew bread without moving their tongue.  I give them a whole medicine cup full of Tic Tacs and tell them to swallow them.  I have also blind-folded someone and then fed them pureed foods, in the same manner they feed the patients, large, over-flowing spoonfuls, one after another. 

I also go over the signs and symptoms of dysphagia.  Certainly coughing/choking will indicate dysphagia, but also difficulty chewing, difficulty swallowing pills, complaint of food sticking in their throat, pain, weight loss, etc.  Most of the nursing staff I have encountered do not understand dysphagia nor do they understand how we treat it. 

Always make sure and go over the treatment methods.  We use compensatory strategies for a reason, along with maneuvers, strengthening exercises, NMES, DPNS and thermal-tactile stimulation.  I don’t go into great detail about the treatment methods, however a little education can go a long way.  Once doctors and nurses understand what we are doing and that we can rehabilitate the swallow, they tend to recommend speech more for patients.

In previous posts, I have stressed the importance of educating the patient.  Our job is continual education.  I live in a very rural area, in fact I work in a 25 bed hospital.  Most people in our area do not know anything about dysphagia.  Education for the public and doctors and nursing is what has helped me to increase my referrals.  I started in the hospital in August of 2009 with maybe 3-4 patients a week.  I know regularly have 12 or more patients on my outpatient caseload and receive 2-4 inpatient referrals. 

Once others understand what you are doing, they not only have more respect for your work, they will also tend to send you more appropriate referrals. 

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