Today, I’m taking a look at the Second Part of the Radiation Associated Dysphagia (RAD) course from Dr. Kate Hutcheson available on MedBridge.
This course, Radiation Associated Dysphagia (RAD) Part II: Evaluation and Management which you can find here.
The first part of the course was all related to learning as much as possible about etiology of swallowing following radiation treatment and learning terminology related to tumor, nodes and metastasis.
Part 2 focuses heavily on management and treatment of RAD. The course looks at outcome measures used at MD Anderson, compensatory strategies, incidence of G tubes and Dysphagia Bootcamp (therapy program).
My takeaways from this course:
Radiotherapy often effects a critical swallowing structure.
Tissue effects can be: edema, fibrosis, denervation
Dysphagia can be graded. Grades include:
- 0-No dysphagia
- 1-Symptomatic, eats a regular diet.
- 2-Symptomatic-eats an altered diet/altered swallowing.
- 3-Severely altered-Tube/TPN/hospitalization indicated.
- 4-Life-threatening-Needs urgent intervention.
Pathophysiology of RAD: Mechanics: Laryngeal closure, Bolus closure, Esophageal opening
- Eat and exercise is indicated: Remember 1 of the 10 Principles of Neuroplasticy is Use it or lose it.
- Therapy may include compensations to normalize the swallow as much as possible.
- When looking at a Home Exercise Program (HEP), the HEP is often not followed and there is a lack of progression of the exercises included.
- Dysphagia Bootcamp looks at 2 areas: Biofeedback or tool based (Surface Electromyography sEMG, Iowa Oral Performance Instrument IOPI, Expiratory Muscle Strength Training EMST) and MDTP or bolus driven exercise.
Just remember, the assessment of dysphagia, whether it is due to head and neck cancer or not, is your building block to developing an appropriate treatment plan. The treatment plan is how you will most impact the swallowing. When you use a thorough assessment protocol and determine the pathophysiology of the swallow, you are able to develop an efficient plan for your patient and hopefully will be able to impact the swallowing function of your patient.
You don’t currently have a subscription with Medbridge? Not a problem! We have you covered!! For $95 a year, you can have access to this course and many other great courses covering a wide variety of SLP-related topics.
Go here to sign up today!!
Use the code DysphagiaRamblings at checkout! (I do make a small amount of money for each person that signs up under me, however this all goes right back into the blog!)