5 Considerations for Continuing Education

If you are like me, you are inundated with social media advertisements for various certification or continuing education courses.
The question is…..which do you choose?

We most certainly can’t afford to attend every course or obtain every certification.  So how do we figure out which courses are worth our time and money?

  1.  The course is ASHA approved for CEUs-Be aware.  Just because the course provides you with ASHA CEUs doesn’t necessarily mean that it is a good course.  While courses are required to be peer-reviewed for ASHA, that doesn’t mean the course is the cream of the crop.  ASHA also does not endorse any specific treatment or tools.  We still have to be conscientious learners.
  2. The course offers “fast” results-I have had the very few patients that met their goals in a short amount of time.   When we work with patients with dysphagia, we are typically working on changing muscles.  This involves strength, coordination and timing.  I can’t go to the gym and strengthen my arms in “just a few sessions”.
  3. Watch the evidence base-A new course can have 150 different references to “support” it’s use.  Read the evidence.  Some may not even be related to the technique you are learning.
  4. Does it really make sense?-The presenter may have you convinced by the end of a course or even through the advertisement that this new technique works wonders because of x, y, z.  Sit down and think about this.  (This is where our critical thinking caps must be ready to go!)  Does this technique make sense?  If I have a patient concentrate on working their knee, is that really going to change the swallowing system?
  5. Use your social media-Post in Facebook groups, use Twitter, Pinterest or even the ASHA SIG groups to question new courses and techniques.  You shouldn’t have to shell out thousands of dollars on a technique that doesn’t work.  You can absolutely keep an open mind to new techniques but maybe others in these forums can help you problem-solve why these techniques may or may not work.

We all work hard for our money and time is a precious commodity.  Choose continuing education and new techniques with care and always hold the welfare of your patients paramount.

What are some courses you have really enjoyed or wish you would have skipped?

What do you think would be the best resource to use to share and look up quality, evidence-based continuing education courses?

Productivity and the SLP

One of the top concerns of Speech Language Pathologists in the healthcare world is the topic of productivity.

A Google search of the word productivity:

  1. the state or quality of producing something, especially crops.
    “the long-term productivity of land”
    • the effectiveness of productive effort, especially in industry, as measured in terms of the rate of output per unit of input.
      “workers have boosted productivity by 30 percent”
      the rate of production of new biomass by an individual, population, or community; the fertility or capacity of a given habitat or area.
      “nutrient-rich waters with high productivity”

    Productivity in a facility such as a hospital or Skilled Nursing Facility (SNF) is measured by the amount of time spent working directly (or billed) for patients divided by total time in the facility.

    Many SLPs are reporting productivity expectations of 90% or higher.  

    A productivity of 90% would be 432 minutes of your work day spent in therapy with patients out of your 480 minute (8 hour) work day.  This leaves 48 minutes of your work day for paperwork, conferences, meetings, bathroom breaks, consultation with other disciplines, etc.

    Why is productivity difficult to achieve?

    The person you are looking for is never where you go to find them.  There are times that you may have to search the entire facility.  There are at least 270 places to hide and to search to find the last person you need to see on your list.  The person that has to be seen on THAT day and for xxx number of minutes.  You may spend 20 minutes of your day just finding someone who knows where the person for whom you are looking is hiding!


    Point of care documentation (documenting as you are treating) is a great idea, but sometimes it is very difficult to actually complete.  You may have every intention of giving your patient/client some work to complete as you document but in our field, that can be difficult.  We may be working on cognition where the person requires your undivided attention to complete anything.  You may be working on swallowing and need to cue your patient through every therapeutic trial or swallow.

    Documentation is so important as it is a written account of your session.  This is not only what gets your facility reimbursed by insurance, but it also highlights outcomes and progress and is your protection should you ever have to defend your therapy in court.  Documentation is also where another SLP can determine what you have been doing so that they can step in and take over should you go on vacation or get sick.

    Why do we need time for consultation with other disciplines?

    Outcome based therapy is a direction in which our field has been moving for years.  Our reimbursement is becoming bundled and will very much depend on the effectiveness of our treatments and a decrease in the rate of re-hospitalization.  When we are talking about patients with swallowing difficulties, being able to consult with others that help to care for the patient is crucial.  The SLP needs to be able to talk to nursing and let them know the patient needs to have nectar thick liquids and use a chin tuck with their pills crushed and given in applesauce.  The nurse may not see a note if you leave it.  The Physical Therapist may get the patient, not realize they are on thickened liquids and give the person water during their therapy.

    Consultation between facility SLPs is equally as important.  We all know that documentation from the Modified Barium Swallow (MBSS) does not necessarily make it from the acute care hospital to the Skilled Nursing Facility.  What if the SNF SLP then makes incorrect recommendations.

    By having time for consultation, we can provide the patient with the best care possible.

    How do we fix this productivity issue?

    First, I would like to recognize that this is not an issue for every SLP or every facility.  I have been fortunate to have jobs with very reasonable productivity expectations.  I am currently expected to have 27 visit points for home health, which has been more than obtainable on a regular, full week.

    This topic is a hot one on Facebook.  How do we fix this problem?  As long as there are people “achieving” this productivity standard, it won’t change.  SLPs are often faced with clocking out for documentation, consultation or even bathroom breaks.  Showing the ones that expect such a high level of productivity that it can be achieved, will never make this issue go away.

    What is your take on productivity?  What is your productivity expectation?


Top 10 Blog Posts for 2016

2016 was a busy year here at Dysphagia Ramblings.  Unfortunately, the blog took the hit in the fight for time.

During 2016, Dysphagia Ramblings published 13 new blog posts.  Thank you to all for reading my posts and for always encouraging me just when I need it.

I’m participating in the Ultimate Blog Challenge, so there will be a new blog post everyday in January!  Plus there are exciting new additions coming to Dysphagia Ramblings.  I know I’m excited and hope that you are as well!

So, what were the top 10 blog posts for 2016?  Here you go!  Click on the title if you would like to reread the post for a re-fresher or if you would like to read it for the first time!  Here’s to a strong 2017 in blogland!

1.  “Aspiration Risk”  Take a look at the term “aspiration risk” and why we need to really think about this term before labeling our patients.

2. Carbonated Beverages  Explore the use of carbonated beverages and it’s sensory benefits.  Spoiler alert-carbonated beverages do not equal nectar thick liquids!

3. The Cost of Thickened Liquids  What does the use of thickened liquids really cost our patients?

4.  ACP and sEMG:  Synchrony for Dysphagia Taking a look at the new Synchrony system from ACP.  More than just a video game.

5.  CTAR (Chin Tuck Against Resistance) Using a chin tuck as an exercise rather than just a compensatory strategy.

6.  Exercises, Techniques, Compensations  Explore various exercises, techniques and compensations used in dysphagia therapy.

7.  Oral Care  Take a look at oral care and prevention of aspiration pneumonia.

8.  Respiratory Muscle Strength Training  What applications to dysphagia can we see from RMST?

9.  Thickened Jello?  Eileen from Simply Thick shares her recipe for thickened jello.

10.  Gelmix Thickener  A look at Gelmix thickener.

I am definitely looking forward to what 2017 brings!!  What are some topics that interest you?


One Little Word

Last year, I decided to adopt one little word that would spark my 2016.  My word was change.  Change for me ended up being attitude, job and habits.  I’m not completely there but still working.

That’s why my word for #onelittleword2017 is GROW.  I have so many areas in my life that I want to cultivate and GROW this year. 



I want to grow my blog.  I never believed when I started blogging 6 years ago that I would have been so blessed in my blogging and I would like to thank each and every one of you that read my blog for helping me grow over the past 6 years.


I want to continue to grow my education.   Not just take continuing education courses for the credits but continuing education for learning.  I want to continue to grow my education.


My goal for this year is to read at least 1 journal article every week in 2017.  Reading more is absolutely ok.   As long as I get 1 a week, meaning I will have read 52 articles for this year.

What are your goals for the year.   What is your #onelittleword2017?

Rolling into the New Year



Every year people set resolutions.  People want to lose weight, make more money or do good in the world.  How about resolutions for your professional life? Have you ever decided to professionally improve for the new year?

Sometimes a better way to look at resolutions is to set goals for yourself. We set goals for our patients every day however we often don’t create achievable goals for ourselves.

We often said ourselves up for failure for the new year. We may create a resolution that will lose 50 pounds by a certain date however we never make that resolution into steps to get there.  When we want to patient to achieve a certain goal we create a long-term goal bit then we give them obtainable steps to get there.

Here are ideas for a long-term goals to set for your professional life for 2017.

1.  Treat your patient like you would treat a family member.

It is so often easy to think of a patient as just that a patient and forget that they are also a person and somebody’s loved one.  Our job as a speech language pathology us is to provide the best possible care and to help our patients achieve the best possible outcomes.

2.  Educate your patients.

This is an area that can sometimes be difficult but is very necessary. Often times our patients with dysphasia have never heard of problems with swallowing. We may be the first person that has ever mentioned A possibility of swallowing difficulties with this patient. To create patient by an aunt to help achieve patient compliance we need to explain to them a normal swallow and how their swallow is different. We also need to explain to them what we’re doing with them and why. Telling somebody to stick their tongue out 10×3 times a day and not ever explaining why you’re asking them to do this will make them question what we’re doing and very possibly decrease their compliance with the task.

3.  Educate yourself.

Continuing education is mandated in our field. This is because there is ever-changing information particularly in the area of dysphagia. We need to keep aware of current trends and change our therapy to reflect these changes. If we continue to do the same thing over and over with a patient we can’t hope for different outcomes. We can’t hope for different outcomes using outdated methods of treatment that have new evidence that show they are not effective.  See my previous post on five considerations for continuing education.

4.  Advocate for yourself.

If you’re unhappy with your work environment maybe it’s time to make a change. There’s been a lot of talk on Facebook recently regarding productivity standards in various facilities across the United States. Most times these productivity standards come about because people actually achieve these standards. Most times a very high productivity is often meds because the person may be documenting off the clock or doing work off the clock. If we want these productivity standards to change we have to take a stand and let our supervisors know that this is not possible and is not beneficial to the care that our patients deserve. Document what you do each day that is both productive and nonproductive. Show how your nonproductive time is beneficial to patients safety and can help reduce risk of re-hospitalization. Be creative and let the people requesting a high productivity know that it cannot be done with ethical care.  If a high demands continue to be placed on you maybe it’s time to look for a new job.

5.  Don’t be afraid to ask for an instrumental evaluation.

Just like our patients deserve the best care possible they also deserve the best assessment possible. Research has shown us that various aspects of the bedside clinical swallow a valuation are merely guesses.  The only way to evaluate the oropharyngeal swallow after the mouth is closed is through instrumental assessment. Dr. James Coyle has often stated that a bedside clinical assessment is merely a series of screens.

6.  Stop being afraid of aspiration.

When an instrumental screen is completed, it is not just to see aspiration or penetration.  We’re looking at the anatomy and physiology of the swallow.  If a patient aspirates during an instrumental study that does not mean it’s time to stop the study.  That means it’s time to investigate the why the person is aspirating and see if you can help to stop the aspiration.  Remember that there are functional aspirators that may never develop respiratory compromise.  If you focus on aspiration, there are so many other deficits of the swallow you may miss.

7.  It’s time to dispel those myths.

Let’s make 2017 the year we dispel those old dysphagia myths.

A chin tuck does not always eliminate aspiration.  In fact, it often CAUSES aspiration.

Runny nose and watery eyes in isolation are not indicators of aspiration.

A drop in oxygen saturation and checking temperature following meals have no proven link to aspiration.

Cervical auscultation has not been found to be a reliable assessment for aspiration or dysphagia.

Deep Pharyngeal Neuromuscular Stimulation (DPNS) still has no published peer-reviewed research to support its use.

However you choose to ring in the new year, let’s make 2017 a great year for Speech Language Pathologists assessing and treating patients with dysphagia!  What are some of your professional goals for this year?


Ramblings from ASHA16

Another ASHA convention has come and gone.  ASHA, for me, is a time that I wait all year for those 5 wonderful days of randomly and sometimes it’s intentionally running into friends from all over the US.  It’s a time of vowing every year that I will make it through the entire exhibit hall and never do and will go to X number of courses.  

For many, the planning begins at the beginning of the year.  People write their abstracts, submit them to ASHA and then wait for months to find out if they’re presenting.  After a long wait, emails start flying in, either a congratulations or “we’re sorry to inform you”.  Registration and housing opens in August with the internet flooded with SLPs and audiologists trying to get the best and closest room available.  Then it’s wait again until November.

The first sign of ASHA is always going to the airport, getting on the plane and trying to figure out who will also be attending the convention.  Poster tubes and planners can be found all over as people are excited to present their poster or planning their sessions as they wait.  

I was fortunate to attend several live sessions and poster sessions this year.  

My favorite poster session, by far was by Brenda Arend and Vince Clark on Starting a FEES Program in your Healthcare Setting, The Benefits and Barriers.  They were a popular poster and a wealth of information!  If you are on Facebook and a member of the Dysphagia Therapy Group Professional Edition you can find the information on their poster session here.   If you are not a member of the group and would like to be, send us a request!

My favorite live session this year was the session by Dr Michael Crary, Dr Giselle Carnaby and Lisa LaGorio, Using MDTP (McNeill Dysphagia Therapy Program) to Rehabilitate Severe, Chronic & Treatment-Refractory Dysphagia: A Review of Multiple Complex Cases.  This course was most likely my most tweets at the convention.  Not on Twitter?  I’ll share them here.  

I took the MDTP course 4 years ago!  I can’t believe it’s been that long!!  You can find my post here.

Sometimes we do the different assessments but then treat each patient the same.

The exercise is actually swallowing.

Promotes continuity of care with specific timelines and advancement, regression.

Frequency and intensity are high while burden on the patient is low.

MASA, FOIS, VAS (Visual Analog Scale), weight, improved swallow efficiency to assess.

Physiology-Fluoroscopy, increased lingual-palatal pressure, hyolaryngeal excursion, pharyngeal contraction, more efficient swallow.

5 articles available on

No treatment should ever work for everyone.
Patient with history 5 years 6 months dysphagia. PEG and NPO. Dysarthria, lingual weakness, weak cough.
Case 1 aspiration with all consistencies.

Case 1 15 day program. Progress is not lineal. There is a model learning component to

130 to 150 swallows per session.

Accuracy is 8 out of 10 successful swallows.

Focus on enhancing the motor planning for patients when necessary.

Case 1 post Botox and still aspiration but also some swallows.

Success is not always “no aspiration”.

Can push diet and advancement with cognitive and motor planning treatment.

Severe motor planning deficits may take longer to rehabilitate.

Patient may needs to unlearn faulty behavior.

Ice chips are the beginning of the protocol.

Unexplained weight loss can be our nemesis in therapy.

Sometimes a FOIS level 5 may be functional for a patient.

Some patients are ok being a functional aspirator.

can be completed in acute care, rehab, outpatient. You may just need to start at ice chips and advance as cognition improves.

may be a replacement for traditional exercises in appropriate patients.

is working to put everything together for the patient.

The program is to challenge the system and wake it up.

Once initial fears subside in patient there was rapid progress.

A well performed careful assessment is everything.

Psycho social issues can reduce movement/swallow progress.

Mia information and lack of systematic progress can reduce progress.

Careful systematic therapy can succeed by supporting self practice.

A lot of techniques we have learned don’t always work.


Patients are not static. Sometimes patients “treat” themselves or don’t follow our recommendations.

New study, was superior to traditional therapy and to and NMES combined.

Here is MDTP in a nutshell or a series of Tweets.

Another great session was by a group of experts in the field, Joe Murray, Debra Suiter, Pam Smith and Jaqueline Hind titled The Practicing Dysphagia Clinician: What Are We Afraid of?

There was a lot of great conversation with this talk as they presented a case and allowed for audience participation and discussion.  One of the comments that brought about a lot of conversation was the topic of the diet waiver.  What do you think of the waiver and do you use them in your facility?  How do you feel we can better “cover our butts”?  

I still can’t believe the convention is over and I will have to wait another whole year to see my friends and speech family!!   








ASHA 2016

Where did the time go?   I can’t even believe that next week is the ASHA convention!  After a long week it is time to start packing because if you’re like me packing early is a must!!!

Now it’s time to make my packing list!  

Comfy clothes (I’m not presenting and have no intention of dressing up! Long sessions and much learning calls for comfort!)
Comfy shoes (There’s A LOT of walking!)

Light bag (To carry my iPad and chargers. Nothing heavy because it is a long day and did I mention a lot of walking?)

Hygiene supplies (Shampoo, soap, the works. Don’t forget the deodorant…..long days, miles of walking!!)

Sweater or light jacket (Some rooms are hot and some rooms are cold.)

My list of sessions. (There is nothing worse than arriving at the conference and having no clue where to go. There are computers to create and print your agenda, however they can be very crowded.). I also try to double-book sessions in case one might be full or let’s face it, I just might change my mind.

Portable charger (I use a New Trent which will charge my phone and iPad fully at least once if not more.  I always go for a charger with a high mA output.)

Power strip or multi USB charger. (Let’s face it, hotels often don’t have enough outlets for all your electronics and if you have a roommate or 3, you will definitely need the extra charging space.  

A small first-aid kit. (You never know when a headache will come on or you need a band aid for blisters from SO MUCH walking!)

An open mind. (There are so many sessions to attend and so much information to learn!! Be ready to learn, not only in your sessions but in the exhibit hall.)

Pajamas (There is very little time to sleep, however it’s nice to be comfy during those brief periods of rest.)

Be prepared to learn, have fun, meet new friends, visit with old friends and enjoy the atmosphere!
Follow @dysphagiarmblng for live tweeting of ASHA 16 dysphagia sessions!