Recently, I conducted a survey regarding dysphagia management/treatment. This was inspired after I read the “Dysphagia Usual Care” article and wrote a blog post about that article.
I found the Usual Care article interesting in how we really have no standardized treatment protocols. While it’s impossible to standardize treatments for all patients or diagnoses we seem to have too wide a variety of treatments.
The results of the survey are as follow:
Which setting do you work?
Home Health Clinic 12%
Physician Office 3%
With which population do you primarily work?
Head/Neck Cancer 39%
Brain Injury 51%
Other 7% (LTC-DD, IR, NICU, PACE, Psych)
Are you a member of:
SIG 13 100%
Dysphagia Research Society 15.9%
What screenings do you use?
50 mL Drinking Test 0
3 Ounce Water Swallow Test 53.4%
Massey Bedside Swallowing Screen 9.6%
Clinical Assessment of Swallowing and Prediction of Dysphagia Severity 5.5%
Clinical and Cognitive Predictors of Swallowing Recovery in Stroke 4.1%
Pulse Ox 46.6%
50 mL Water Swallow Test 1.4%
Gag Reflex 15.1%
30 mL Water Swallowing Test 5.5%
Swallowing Provocation Test 0
Standardized Swallowing Assessment (SSA) 9.6%
Timed Test of Swallowing Questionnaire 4.1%
Ox Sat Monitoring 46.6%
Others: (Frenchay, FOIS, Blue Dye, Facility Specific, MGH, Bedside Swallowing Assessment, C.A., SAFE, Dysphaiga2Go, Informal, MASA, Observation)
What dysphagia assessment tools do you use?
Informal Assessment Only 34.3%
Cervical Auscultation 23.2%
Hyoid/Laryngeal Palpation 69.7%
Observation at meals 80.8%
Cranial Nerve Exam 47.5%
Other: (Facility Specific oral care tool, clinical bedside, SwalQol, EAT-10, pulse ox)
Do you use MBSImP?
Do you currently use a standardized assessment form (MASA)?
What outcome measures do you use?
ASHA NOMS 63%
Swal Qol 7.4%
Swal Care 1.2%
Pen/Asp Scale 38.3%
Other (Observation, FACS, ROMS)
How do you frequently treat your patients?
During meals 5.1%
As a separate therapy session (outside of meals) 14.3%
What therapeutic tools do you use?
NMES (other than VS) 9.8%
Ora Light 4.3%
Ice Fingers 21.7%
Laryngeal Mirror 18.5%
Tongue Depressors 71.7%
Chewy Tubes 20.7%
NUK Brushes 18.5%
Thermo Stim 30.4%
Tongue Press 5.4%
ARK Probes 2.2%
ARK Grabbers 4.3%
Safe Straws 5.4%
The Breather 16.3%
Provale Cups 40.2%
Wedge Cups 23.9%
Other (Nosey Cups, Maroon Spoons, Beckman Exercises, Myofascial Release, Exercises)
What therapy do you use?
Pharyngeal Exercises 93.8%
Oral Manipulation 45.8%
BioFeedback (sEMG) 12.5%
Thermal/Tactile Stim 60.4%
Pressure Feedback (IOPI) 10.4%
Weighted Bolus 24%
Other: (Myofasical Release, Other Laryngeal Strengthening, Lingual with Resistance, LSVT-Like, Oropharyngeal Therapy)
What apps do you use for dysphagia therapy?
Swallow Now 2.1%
Small Talk Dysphagia 9.4%
Resource Apps (Drug apps, Lab Tests, Cranial Nerves) 15.6%
Other (VU Meter)
What techniques do you employ with your patients?
Diet Alteration 99%
Chin Tuck 91.9%
Multiple Swallows 94.9%
Effortful Swallow 90.0%
Mendelsohn Maneuver 70.7%
Alternate Consistencies 91.9%
Alternate Temperatures 48.5%
Limit Bolus Size 92.9%
No Straws 82.8%
Head Turn (Left/Right) 72.7%
Cough/Throat Clear after the Bolus 85.9%
Supraglottic Swallow 67.7%
Super-SupraGlottic Swallow 54.5%
Lemon Ice After Bolus 11.1%
Other (Sensory Techniques, Masako, Reflux Precautions, Chin up, Olfaction Stim)
The Facebook Dysphagia Therapy Group Professional Edition was asked to define pharyngeal exercises. Answers included:
Effortful Swallow with TheraSip
Resistive Jaw Exercises
After conducting this survey, there are a few things that really stand out to me:
First, we finally have 2 standardized assessment tools in the MASA and the MBSImP with approximately 10-15 in 100 SLPs utilizing these tools.
Most SLPs (80%) are treating at meals and separately. Dr. Logemann specifically states that we should be treating outside of meals, as do many of the major dysphagia researchers. We also seem to not utilize instrumental assessment as often as mealtime observation. Unfortunately this may be in large part to denials for instrumental exams due to high cost.
One thing we need to work towards is not only standardizing what we do (as much as possible) but standardizing our terms including modalities, techniques, screenings, assessments and objective measures.