I have often wondered what others that work in the area of dysphagia do during therapy. I always want to know what tools they use and what books they recommend, so I made a survey. Actually I made two.
First, I sent out 75 surveys, in the surrounding areas in Indiana (mostly central). I received 13 of the surveys. Ok, 12 because technically I did one as well. Most of the surveys came back to me partially completed. I have the results posted on Scribd.
As a whole, we had an average of 10 years of practice, with the shortest time being 2 years and the longest being 30 years or more. Most therapists work in a SNF (Skilled Nursing Facility). One concerning factor for me was the lack of use of a standardized bedside assessment. In our realm of changing and more evidence-based therapy/healthcare, can we really continue to afford to use only our judgement with no real data to back up our findings??
Another concerning finding to me is that the most widely used therapy technique is diet alteration at 85%, which tied with oral exercises. Perhaps, a new survey should be devised to determine what people consider oral exercises. I realize that in SNF’s there will always be those patients that require a diet change and are not appropriate rehabilitation candidates, however SNF’s are also becoming widely known for rehabilitation.
Techniques that actually engage the swallowing function and tax the system to bring about an actual change, such as the Mendelsohn, the effortful swallow, etc, were only reported to be used 46-38% of the time. I guess this would also explain why the average percentage of return to a normal diet was only 50% with most likely, spontaneous return accounting for some of the return.
Expiratory Muscle Strength Training (EMST) is an emerging therapy incorporating respiration strengthening with swallowing exercises. Items such as The Breather were only incorporated into therapy by 1 therapist. Of course, keep in mind, this was a very limited survey response, it still, I believe, paints a big picture of how our therapy looks.
With the limited number of surveys that were returned to me per mail, I decided to also create a survey by Survey Monkey. This survey had a response from 44 therapists. Again, the majority of the therapists from this survey work in a SNF. The most widely used therapy “tool” is tongue depressors. I’m guessing because it’s the most accessible tool we can get. The Breather/Spirometer for EMST was still fairly low on the list with 14-17% usage and the Iowa Oral Performance Instrument (IOPI) was at 9.5%.
Again, the most popular therapy technique is diet alteration at 95%. Some of the rehabilitative strategies we use such as the effortful swallow, Mendelsohn, etc.were used by 50% or more of the respondents.
I think that one important thing we can learn here is that diet changes, head turns, chin tucks, double swallows are not “rehabilitative”. They create a safe swallow for the present time while we rehabilitate the swallow for a diet upgrade. While we may have our patients on an altered diet or have them employ compensatory strategies, we also need to work the patient, use that effortful swallow, the Mendelsohn. Work the swallow system and make it work like it should. That is rehabiltiation. When we bring about a change, we rehabilitate.
Most of us do recommend The Source for Dysphagia by Nancy Swigert as our favorite book.
I think the main thing we need to ask ourselves when treating our patients with dysphagia is, “Am I doing everything I can to rehabilitate my patient?” Then ask yourself do you feel comfortable in saying yes you are. Treat your patients as you expect to be treated.