Sometimes in our professional career we see, read or hear something that goes against everything we’ve learned where everything we think we know. I recently wrote a blog post about three things we need to stop doing and dysphagia assessment and treatment. That post was a challenge.
Sometimes we have to step out of our comfort zone and realize that what we’re doing needs an upgrade. Research and dysphagia is constantly evolving and showing us what we should and should not be doing.
There is no all or nothing and there is no cookbook recipe to assessing or treating dysphagia. What we need to become competent in is reading the research articles. These articles are not all or nothing. We may have a patient that the Mendelsohn maneuver is a perfect contribution to their therapy program however have 10 other patients for whom the Mendelsohn maneuver is not an option.
Research gives us a guide to help us develop an appropriate program for each patient.
When we sit in the dining room day after day and watch patients eat it downplays our role as a pathologist. We become an aid or a waitress to many of the patients in the dining room. Now that’s not to say that there aren’t appropriate times to assess the patient in the dining room. What better way to assess the patient at mealtime? It is however not a skilled treatment when we sit in the dining room day after day assessing or monitoring patient tolerance.
What we need to do as a profession is to become skilled at prescribing an appropriate therapy program for dysphagia. There is an article by Dr. Gisele Carnaby called usual care and dysphagia therapy that was very eye-opening. Dr. Carnaby and colleagues found that given one scenario they were provided with over 90 treatment plans and no two treatment plans were the same.
When we keep up with the research and new developments in our field we know that we can begin to standardized our assessment and treatment with programs such as:
- The Modified Barium Swallow Impairment Profile- A standardized protocol to completing and analyzing the MBSS (modified barium swallow study).
- The McNeil Dysphagia Therapy Program- A systematic, exercise based therapy program using food as resistance.
- Pharyngocize- A protocol developed for patients with head and neck cancer.
- Expiratory Muscle Strength Training- A program developed to increase respiratory muscle strength for increased cough response and swallowing ability.
Let me know your favorite evidence-based protocol.
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., … & Blair, J. (2008). MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia, 23(4), 392-405.
Crary, M. A., Carnaby, G. D., LaGorio, L. A., & Carvajal, P. J. (2012). Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. Archives of physical medicine and rehabilitation, 93(7), 1173-1178.
Lan, Y., Ohkubo, M., Berretin-Felix, G., Sia, I., Carnaby-Mann, G. D., & Crary, M. A. (2012). Normalization of temporal aspects of swallowing physiology after the McNeill dysphagia therapy program. Annals of Otology Rhinology and Laryngology-Including Supplements, 121(8), 525.
Carnaby-Mann, G., Crary, M. A., Schmalfuss, I., & Amdur, R. (2012). “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. International Journal of Radiation Oncology* Biology* Physics, 83(1), 210-219.
Pitts, T., Bolser, D., Rosenbek, J., Troche, M., Okun, M. S., & Sapienza, C. (2009). Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest Journal, 135(5), 1301-1308.