Measuring Lingual Range of Motion

For so long, we have focused on lingual strength and range-of-motion.

The Iowa Oral Performance Instrument (IOPI),  the SwallowStrong and the Tongue Press have all been developed to give us visual and numeric strength measurements of the tongue.

We finally have a measurement scale for lingual range of motion.

C.L. Lazarus, H. Husaini, A.S. Jacobson, J.K. Mojica, D. Buchbinder, K. Okay, M.L. Urken.  Development of a New Lingual Range-of-Motion Assessment Scale, Normative Data in Surgically Treated Oral Cancer Patients.  Dysphagia (2014) 29:489-499.

This study compared results in treated surgical patients vs. healthy patients.   36 patients s/p oral tongue surgery with significantly decreased tongue range-of-motion and 31 healthy individuals.

The scale was validated by correlating range-of-motion with performance status, oral outcomes and patient-related Quality of Life.

The scale was made to define lingual deficits.  This is a tool that can be used for baseline and post surgery tongue range-of-motion and to track changes over time with recovery and therapy.

Lingual protrusion was measured using the Therabite jaw range-of-motion measurement discs.

Protrusion Scores:  (100) Normal:  > or = 15 mm past the upper lip margin

(50)   Mild-mod:  >1mm but <15mm pasat the upper lip margin

(25)   Severe:  Some movement but unable to reach upper lip margin

(0)     Total:  No movement

Lateralization Scores:  based on ability of the tongue to touch the commissures of the mouth.  Measure both right and left side.
(100)  Normal:                      able to fully touch the corner of the mouth.
(50)    Mild-Moderate:  50% reduction of movement to corner of the mouth                                                in either direction.
(25)    Severe:  >50%           reduction in movement.
(0)      Total:                          No movement.

Elevation Scores:    

(100)  Normal:  complete tongue tip contact with the upper alvoelar                                       ridge.
(50)    Moderate:  tongue tip elevation but no contact with the upper                                       alvoelar ridge.
(0)      Severe:  No visible tongue tip elevation

Total Scores were assigned by adding the protrusion score+ right lateralization score + left lateralization score + elevation score divided by 4.

Scores were 0-100:      

0=severely impaired/totally impaired
25=Severly impaired
50=mild-moderate impairment
100=normal

During this study, tongue strength was measured using the Iowa Oral Performance Instrument.

Jaw range-of-motion was measure using the Therabite jaw range-of-motion measurement discs.

Saliva flow was measured using the Saxon test where the patient was asked to chew a sterile 4×4 piece of gauze for 2 minutes then spit the gauze in a cup.  The gauze was weighed before and after mastication.

The Performance Status Scale was used to determine diet type, speech uderstandability, impact of surgery on ability to eat socially.

Quality of Life was measured using the Eating Assessment Tool-10 (EAT-10), MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI).

The study found that lingual range-of-motion can negatively affect all aspects of a patient’s life and correlates with performance and quality of life.

Dysphagia Assessment

So many people assess dysphagia in the same manner, at least from my observations. Sit with them while they eat a meal, feel laryngeal elevation and trial diet modifications. I have rarely seen people do a thorough dysphagia bedside evaluation.

 I’m trying to standardize the manner in which I complete my bedside evaluation. I have started using the SOPE, the MASA and the Sage during every assessment, along with a thorough chart review and assessing aspiration risk factors. I can complete a fairly thorough assessment. The SOPE assesses cranial nerves, taste buds and some muscle function. The Sage assesses oral cleanliness and need for oral care. The MASA has been a fairly accurate indicator of dysphagia from my standpoint. I also do the traditional feel for laryngeal elevation, but I also feel for hyoid protraction. I have started assessing with water and graham crackers. If I need to, I will thicken the liquids, but usually wait for an instrumental assessment. I also have started using the 3 ounce water swallow challenge, which has been a good indicator for aspiration from what I have done so far.

 It is important to assess cranial nerves and to understand the cranial nerves. For instance CN XII, the hypoglossal nerve has no sensory pathways, only motor. This definitely affects the means by which you will treat. Another point that has been drilled into my head is that sensory input drives motor output. If you can increase the sensory input a person receives you can increase the amount of output in the muscle functions. Cranial nerve assessment is vital in understanding dysphagia. Sensory input such as olfactory and optical help to prepare the person for the swallow by increasing saliva and telling the body that it is going to masticate and swallow food/drink. Sensory input can also be established through tactile, thermal, or NMES input. In fact, Vitalstim placement 1 has the highest sensory input of all the Vitalstim placements. DPNS is highly driven by sensory input to the cranial nerves through use of frozen lemon swabs, along with thermal, tactile stimulation (TTS).

 You can actually tell a lot about a person by their oral hygiene. You can tell who will qualify for Frazier Water Protocol. Also, by oral hygiene, you can make an assumption that the person is at higher risk for aspiration pneumonia because of the poor hygiene of the oral cavity. It is important to let nursing and nursing staff know how often to complete oral cavity for patients that are unable to complete this task with independence.

 It is vital to assess motoric function. You treat the motor dysfunction, not the symptoms, i.e. aspiration. If you assess a person and can only tell that they are aspirating, but not WHY they are aspirating, you are no better off than you were before the assessment. There are many areas of function that are vital to swallowing, labial closure, lingual to palate contact, bolus management and propulsion (lingual strength), velar elevation, tongue base retraction, pharyngeal sqeeze, hyolaryngeal excursion (laryngeal elevation, hyoid protraction and hyoid thyroid approximation) and UES opening. I am extremely excited about the MBSImP which will be published next year with certification courses to follow!!

 The 3 ounce water swallow challenge is fairly new. It is an indicator of aspiration as it is believed, people that silently aspirate small amounts of liquid will choke with larger volumes. 3 ounces of water is enough to make a person choke, as it is stated per this protocol that silent aspiration is volume dependent. With this challenge, the person is given 3 ounces of water, either by straw or cup sip. They drink the water continuously. Any coughing, throat clearing or inability to drink all 3 ounces at one time is considered a fail. If the person can continuously drink the water and not cough during or for a minute after the challenge, they pass. Those that fail are then assessed instrumentally.

 Watching a person eat is also very critical to the evaluation. One predictor of aspiration is inability to self-feed. Medication can often affect a person’s ability to swallow, affect amount of saliva a person has to help break-down the food orally or affect the person’s alertness.

 A thorough dysphagia exam is vital and necessary for treatment. A good bedside examination with instrumental assessment will aid you in accurate assessment for thorough and appropriate treatment for dysphagia.

Put Yourself in Their Shoes

My number one rule-of-thumb, especially when treating my dysphagic patients is to put myself in their shoes.

 First, I need to make this patient and their family member understand just what is going on. No, I don’t explain dysphagia in medical terms, but it is easy to put into layman’s terms when you understand the swallowing process. The patient needs to understand dysphagia, what is compromising their swallowing function and understand how and why dysphagia treatment will make them better and safer. Patients need to understand that this can be a life-threatening dysfunction but that it can be improved through therapy, diet modifications, compensations, etc.

 I also have to remember that one of the joys in life is eating. We all go through our day eating and drinking. It’s how we socialize, what we do at holidays. Our patients do not want to continue on a pureed diet with honey thick liquids when there is therapy available to possibly get them to a higher level. I’ve seen too many people discharged from therapy on an altered diet because the therapist has no idea what to do with them. I’ve also seen patients upgraded before they even really have therapy. Upgraded three days after the MBSS with severe dysphagia and aspiration is not an appropriate upgrade.

 Remember that our job as dysphagia therapists is to rehabilitate, or bring about change to the swallowing system and the musculature of the swallowing system. We cannot bring about change by sitting with a patient during lunch and reminding them to tuck their chin. We cannot bring about a change by having them stick out their tongue 30 times a day and think that’s going to improve the swallow. The only true exercise for the swallowing system is swallowing and challenging the patient with the swallow.

Exercise

Recent and some previous dysphagia literature emphasizes the use of exercise physiology. Researchers such Lazarus et. al, Robbins et.al, Burkhead et. al and Clark have published the need for incorporating exercise physiology into dysphagia therapy. They emphasize the need to understand the muscles involved in the swallowing mechanism, understand their function so that you can exercise those muscles in the manner in which they function for the swallow.

 The best way to work and improve the swallowing function is to swallow. Not only simply swallow, but push the swallow beyond it’s normal capacity. One way to incorporate increasing the load of the swallow is to use the effortful swallow, the masako or the Mendelsohn maneuver. The Shaker is a great load-resistant exercise to increase opening of the UES. These exercises have been researched and shown to be effective. Logmemann credits the research that has been established for the Shaker exercise and the lingual strengthening exercises from Robbins to increase lingual strength, with overall strengthening of the swallow.

 I’ve started an exercise approach to my dysphagia therapy. I started using almost like a “circuit” of swallowing training. I give the patient a list of exercises to complete while in therapy. Depending on what they need to focus their therapy, they complete a circuit of exercises. I use a variety of swallowing exercises including the Mendelsohn maneuver, effortful swallow, lingual resistance exercises, oral manipulation exercises. Most exercises include swallowing as part of the exericise. One of my favorite strengthening exercises is sucking pudding through a straw. I have the patient start with a regular drinking straw and work their way down to using a coffee stirrer. This not only strengthens the tongue, cheeks and lips, it also requires that they swallow. They spend x number of minutes of each exercise.

 Taking an exercise-based approach to swallowing is far superior to simply altering diet consistencies or adding compensatory strategies to each swallow. Rehabilitation should bring about a change to the swallow mechanism. I do not nor will I use compensations or altered diets in my therapy. I may put the patient on an altered diet, but I want to work the system naturally, not with a compensation if I can avoid it! Look to your PT and OT departments. They work the muscles to bring about change and we should be doing the same.

 Logemann, J.A. (2005). The Role of Exercise Programs for Dysphagia Patients. Dysphagia. 20: 139-140.

 Clark, H.M. (2005). Therapeutic exercise in dysphagic manamgent: Philosophies, practices and challenges. Perspectives in Swallowing and Swallowing Disorders, 24-27.

 Robbins, J.A, Butler, S.G, Daniels S.K., Diez Gross, R., Langmore, S., Lazarus C.L., et al (2008). Swallowing adn dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language and Hearing Research, 51: S276-S300.

 Burkhead, L.M., Sapienza, C.M., Rosenbek, J.C. (2007). Strength-training exercise in dysphagia rehabilitation: Principles, procedures and directions for future research. Dysphagia, 22:251-265.

 Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12: 400-415.

 Robbins, J.A., Gangnon, R.E., Theis, S.M., Kays, S.A., Hewitt, A.L. and Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatric Society, 52, 1483-1489.

 Lazarus, C., Logemann, J.A., Huang, C.F., and Rademaker, A.W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrice et Logopaedica, 55, 199-205.

The Dummies Guide to Dysphagia

A big shout-out to Tanya for the inspiration for this blog!!!

 Education is such an important part of not only the dysphagia eval, but also throughout therapy.  More than likely the patient/family will have no clue what dysphagia is or that such a condition even exists.  Swallowing is an event that you don’t think about.  Nobody swallows and analyzes their own swallow function (unless you’re an SLP of course).

 My first session with a patient is a large portion of education.  Whether I’m doing a swallow eval or a Modified Barium Swallow Study I’m continually educating.  I find that one of the easiest ways for me to educated patients/families is to explain each part of the eval and how it relates to swallowing.  If I’m checking for labial seal/strength I explain to the patient the purpose of the lips.  My new explanation for the tongue is that it’s like the quarterback of the team.  The tongue is the one that starts the play and makes it happen.  (The Colts have been doing well so everyone in Indiana loves football now.)  I not only educate on the structures and the means by which they function, I show pictures and try to demonstrate as best I can.

 When the patient understands the basics of such a complex and intricate system, they begin to understand how it could falter.  I always make sure that the patient understands that the swallow is something that we do so frequently we don’t even think about it.  I also let them know that the swallow involves a variety of closures, muscles, nerves and actions that all occur in 3-5 seconds.

 I typically have information available for the patient to take home with them.  I have brochures describing how speech therapy rehabs the swallow, information regarding swallowing and a self-test for dysphagia.  The self-test I use is found at  http://americandysphagianetwork.org.

 So, for all those that may read this and not understand dysphagia or know anything about the swallowing system:

 The lips are the first part of the swallowing system.  They have to close, and stay closed to help keep the food (the bolus) inside the mouth (the oral cavity).  The lip seal also helps create a pressure which helps to push the food (bolus) back and down the throat (the pharynx).  The tongue is the main player in the swallow.  The tongue is like the quarterback.  It is the first player to really receive the ball (the bolus), moves it around, getting it ready to “throw” down the line (the pharynx).  When the ball (bolus) is ready, the tongue takes it, throws it back (posterior propulsion) and launches the ball (bolus) down the pharynx.  Once the bolus starts down the pharynx, the airway has to move up and forward to close it off and you hold your breathe until the swallow is completed.  (I usually have the person swallow and feel their Adam’s Apple move up when they swallow.  If they can’t/don’t feel the laryngeal elevation, have them feel your throat.)  When the airway is closed, the food tube (esophagus) and lets the food go down.

 When we are not swallowing, our airway is open, allowing us to breathe and the esophagus is closed.  It switches for a split second when we swallow.  If any of these “tasks” don’t happen during the swallow or if they happen at the wrong time, that causes a problem with the swallow.

 Some of the problems that commonly occur with swallowing are lingual (tongue) weakness causing difficulty moving the bolus back in the mouth towards the pharynx (posterior propulsion), poor labial seal with food/drink falling out of the front of the mouth.  Pocketing is when food sticks in the mouth, usually between the cheeks and the gums.  If the airway doesn’t close off completely then food/liquids can start to go into the airway or go completely into the airway.  When the food/liquid goes into the airway, that is called aspiration and can lead to respiratory difficulties such as breathing difficulties, bronchitis, pneumonia or even death.

 Another problem that can occur in the pharynx is residue.  There are two pockets in your throat, one is called the valleculae and is located just above your airway.  The other is called the pyriform sinus and is above the esophagus.  If there is not enough pressure or force from the back of the tongue pushing the bolus down the throat and against the wall of the throat (posterior pharyngeal wall), the food can stick in these pockets after the swallow.  When food/drinks remain in the pharynx, the person may aspirate (the food/drink goes into the lungs) the residue once they breathe again.

 Another major part of the swallow that can “go wrong” is that the esophagus doesn’t open, or doesn’t open enough for the entire bolus to enter the esophagus.  The esophagus (upper esophageal sphincter-UES) is opened by the upward and forward movement of the airway (hyoid/larynx) and the pressure of the bolus.  Typically when the UES opening is compromised, the person will have pyriform residue, which may then be aspirated.

 There are many techniques/therapies to aid in rehabilitating the swallow mechanism.  Most commonly, people are placed on altered diets, or taught compensations such as chin tuck or head turn to stop aspiration/residue.  These alterations/compensations DO NOT improve the swallow, but may serve to eliminate the aspiration or risk of aspiration.  Swallowing is a muscle based system, powered by 6 cranial nerves.  We have to take an exercise physiology approach to rehabilitate dysphagia.  We can learn much from our physical and occupational therapy counterparts.  To train a person to walk, they have the person walk.  They may have them use a walker, but the ultimate goal is to have them walk without the walker or with independence.  The walker makes the person safe at the time, but does not “fix” the problem.  By the same token, we may put a person on an altered diet, or say, honey thick liquids.  This makes the person safe at the time, but does not “fix” the problem.  We work on strengthening those swallowing muscles to allow the person the opportunity to swallow with independence and to again swallow thin liquids.  Just as the physical therapist will work with the person walking without the walker in therapy, although outside of therapy the patient will probably still need to use the walker, we need to work with our dysphagia patient on swallowing thin liquids in therapy.  This may be a teaspoon of the liquid at a time.  By using the thin liquid, a little at a time, you are training the person to swallow.  You may use techniques such as the Mendelsohn or the effortful swallow to strengthen the muscles through resistance.

 I use VitalStim or neuromuscular electrical stimulation during swallowing therapy.  I place the electrodes so that they stimulate the impaired muscles during swallowing therapy.  If the person has decreased laryngeal elevation or the airway doesn’t close during the swallow, then I target the muscles that elevate the larynx.  The tongue is attached, via muscles, to the hyoid bone, which is part of laryngeal elevation.  So take the patient with decreased laryngeal elevation.  This person has aspiration with thin liquids but is safe with nectar thick liquids.  When using the Mendelsohn maneuver, the patient was able to safely swallow 5 ml of thin liquids.

 My therapy session would look like this:

At home, the person is drinking nectar thick liquids.  In therapy, I’m going to place the VitalStim electrodes on the laryngeal excursion muscles.  I like circuit therapy, I say it’s like Curves but for swallowing.  The patient will complete all exercises/swallows while the VitalStim is on.  We do lingual strengthening exercises using a tongue depressor (the patient pushes their tongue out, up and side to side against the tongue depressor), practice the Mendelsohn maneuver using dry swallows, when they are able to complete the Mendelsohn I would have them start using the Mendelsohn with 1ml water, working up to 5ml of water.  Therapy should always have many opportunities for swallowing (you can only exercise the swallowing system by swallowing).

 Vitalstim electrodes are attached to patient and VitalStim is turned on to a therapeutic level.

5 minutes of dry swallows using the Mendelsohn

4 minutes push your tongue out against the tongue depressor

5 minutes suck pudding through a straw (my FAVORITE exercise)

4 minutes push your tongue up against the tongue depressor

5 minutes pull your tongue back as far as it will go in your mouth, hold 5 seconds

4 minutes push your tongue to the right against the tongue depressor

5 minutes dry swallow using an effortful swallow

4 minutes push your tongue to the left against the tongue depressor

5 minutes pudding through the straw

5 minutes pretend to yawn and hold tongue back for a count to 5

5 minutes swallow pudding using an effortful swallow

 Now, keep in mind, the tongue is the quarterback of the swallow.  It is attached to the hyoid via muscles.  The person needs their larynx to elevate so I’m going to work on strengthening the tongue, to strengthen the hyolaryngeal excursion.  The Mendelsohn provides hyolaryngeal excursion through resistance of gravity.  The effortful swallow has been found to strengthen the overall swallow.  Tongue base retraction is part of the tongue which is going to aid in the hyolaryngeal excursion.  I like the pudding through the straw (I start with a regular straw and work to a coffee stirrer, my way of adding “weight” to the exercise) because it strengthens labial seal, the buccal (cheek) muscles, works on tongue base retraction, the person has a bolus to manipulate and then they have to swallow.  The pudding through a straw offers resistance to the oral phase of the swallow, by adding an effortful swallow, you add resistance to the pharyngeal phase as well.

 Keeping in mind the basic anatomy and physiology of the swallow, it just makes sense that exercise should offer resistance, making the task more difficult or require more effort.  Just as if you are trying to build up your arms to look good in your tank tops, you don’t start at 5 pounds and stay there.  You eventually add weight and keep working up.  Swallowing therapy should offer resistance, strengthening and endurance because you are working to improve the timing, speed and strength of the swallowing mechanism.

 

Where Can I Go for Questions Regarding Dysphagia?

You work with dysphagia everyday.  Well, maybe not everyday for some, but you work with patients with dysphagia at least some days.  You have the books, you have paper resources.  Does anyone else keep a binder with information for dysphagia??  I’m working on putting mine on Dropbox so that I can use mine on my iPad.  Where else can you go for information/help with dysphagia?

 First, there is a group on Facebook.  You may have seen it, may even be a member.  The Dysphagia Therapy group has grown more than I could have ever hoped.  This group has been such a great resource for swallowing specialists.  This group has served as a great place for professionals to ask and answer questions and to vent about issues we experience everyday.  We are also getting a number of students who utilize this forum as a means of gaining real world experience by asking professionals questions.  This has also been a great forum to share continuing education experiences, courses and information regarding dysphagia products.  You can join this group at our Facebook site.

 Twitter has become a great resource for all things SLP.  If you belong to Twitter, all you have to do is add the hashtag #dysphagia or #dysphagiapeeps.  Twitter has been such a great resource to ask/answer questions.

 There is a dysphagia maillist.  You email your questions/information to the listserv and will usually get at least one response if not more.  The only downside to this listserv is that it can, at times flood your email.   One complaint of this maillist is that often times the responses to questions can be very negative and often times you feel that you are being told what not to do, but never really what to do.  It also seems to be very heavily geared towards the pediatric population.

 By the same token, ASHA Special Interest Group (SIG) 13 for Swallowing and Swallowing Disorders also offers a mail listserv.  Again, the downside of this is flooding of your email and you have to be a member of SIG 13 (an extra $35 in addition to your dues for ASHA).  The good part of this listserv is the responses are often very positive and informative.  You also tend to hear from some of the “big names” in dysphagia such as James Coyle.  SIG 13 also has their own webpage on the ASHA site and with your membership, you get access to the Perspectives for Swallowing and Swallowing Disorders journal, which is a great resource.  You also, for a fee, can utilize this journal for CEU’s.

The National Foundation of Swallowing Disorders (NFOSD) provides free educational webinars as well as connects patients with qualified speech pathologists.  They publish articles on their site about patients with dysphagia.

 The Dysphagia Research Society is a great resource to therapists.  You can join via a research track or a clinical track.  There are three tracks of membership:  full member is $220 a year and you have to have published research; associate membership requires interest in deglutition and costs $170 a year, however you have full access to the Dysphagia journal; student/trainee membership is $50 a year and requires a letter from the head of the department.  In addition to their website, access to the Dysphagia journal, the DRS also has a conference once a year.  The 2012 conference will be held in Ontario Canada.  I believe that the conference is available for CEU’s.

 The VitalStim website offers great resources, whether you are a certified clinician or not.  The website offers resources, a list of VitalStim certified clinicians and free webinars.  Some of the webinars are for VitalStim certified clinicians only and some are free for all clinicians.

 That Mayo Clinic website offers resources for Dysphagia that would be more appropriate for families/patients.  This would be a great site for clinicians looking for resources for family/patient education handouts.  It might be good for students/new clinicians to start adding to their toolbox.  

 Clinicians that want to specialize in Dysphagia are encouraged to get their Board Recognized Specialty in Swallowing (BRS-S).  The BRS-S website offers CEU’s in Dysphagia.  You can also print the application to obtain your BRS-S with a list of the requirements.  You can obtain this via a research or clinical track.  The clinical track requires evidence of skills in Leadership, Education and Research, along with 75 hours of CE in Dysphagia courses within the last 3 years.  You also have to have 350 clinical hours within the last 3 years.  Once you submit your paperwork with $75 (you can request a mentor to assist you with your paperwork, help you determine if you are ready for BRS-S and set you on track to obtain your BRS-S within 3-5 years.) Once your application is accepted, you can take the examination for an additional $300.  You have 2 chances to take the test without having to pay again.  After the first 2 tries, you have to pay $75 per re-take and can only attempt to pass the exam for the next 12 months.

 The American Dysphagia Network offers CEU’s for clinicians, information on swallowing and swallowing disorders for clinicians and patients and a self-test for Dysphagia that can be completed online or printed and given to the public.  

 Swallow Safely is an amazing book written by Roya Sayadi, Ph.D., CCC-SLP and Joel Herskowitz, M.D. It is a great resource for family, patients, potential patients and clinicians. The book is easy to read, not terribly long and inexpensive. The book runs anywhere from $9.99 to $14.99. It is also available in ebook format, so it provides easy reading on your iPad or Nook.

 Last, but not least, if you own an iOS device (iPad, iPhone, iPod) or an Android system, there are apps available for you to use for Dysphagia therapy. There are not many yet mind you. If you own an Apple device, you can look for: Oral Motor from SmartyEars which is geared mainly towards pediatrics; Lingraphica offers an oral motor app geared more towards adults; Lingraphica also offers a Dysphagia app (Smalltalk) with icons which can be utilized by patients to “speak” words/phrases regarding their swallowing/dysphagia and also videos demonstrating maneuvers such as the supraglottic swallow; iSwallow offers a means of setting up a program for your patient, adding exercises, schedule, instructions and a journal for patients to use for their swallowing therapy; NeuroToolkit includes the NIH Stroke Scale, Coma Scales, SAH/AVM Scales, TIA/Stroke/ICH Scales, Anticonvulsants and Outcomes/UPDRS/Eye/EDSS/MIDAS. This is about it for the Dysphagia apps I have found for iOS. For Android, there are even less. Android offers the MiniMental app which may be helpful in determining cognitive status for you patient, Rancho Los Amigos app which basically just tells you what to expect at each level, and I sometimes use the stopwatch app for my assessment.

Dysphagia2Go-Revolutionizing the Dysphagia App World

Call me a little partial, but I LOVE this app.  Dysphagia2Go has given me a new way to utilize my iPad in my dysphagia therapy.  I also can use it with the confidence that it is HIPAA compliant.  Yes, I am one of the authors, but this app was created out of the need to complete a quick and simple Clinical Dysphagia Evaluation.  This app was created to assist clinicians in assessing all areas for dysphagia and to complete a chart review that is as thorough as possible.

 

When you open the app, you will first begin by adding your patient information.  You can save patients or you can bring up previous patient information.  When adding a new patient, you will be prompted to input a Patient ID, Patient first name, Patient last name, Patient Date of Birth and Physician’s Name.  If you are not comfortable adding a patient name, you can assign each patient a number or simply use initials.

 

One thing you will want to make sure to do is go under settings and add your therapist and institution information.  Turn the information on to add it to your reports.

 

Once you have added that patient, you can either view a saved report, or you can add a new evaluation.  To begin the evaluation, you will select the chart review tab.  The chart review will prompt you to input the reason for referral, physician order (yes or no), diagnosis, current method of nutrition, respiratory status, etc.  There is also a text box that you can input any other pertinent information from your chart review.  Don’t worry, new sections are being added to complete a more thorough chart review.

 

Once the chart review is completed, you can go assess the patient and begin to start the Oral Mech Exam.  This will prompt you to input information regarding all the oral and pharyngeal areas that we assess, including the tongue, teeth, lips, etc.

 

Upon completion of the Oral Mech Exam, you will be able to assess trials.  Either use the consistencies provided or skip the consistencies not used.   For each consistency, you will be able to assess oral control of the bolus, pharyngeal stage of the swallow and add any comments needed.

The final section is the Recommendations section.  You will be able to recommend compensatory strategies, exercises, MBSS, FEES, therapy, no therapy, or referrals.

 

Once the evaluation is complete, you can download the report and either print it wirelessly or email it to yourself and print it.  You also have the option to email it to yourself and cut and paste into your computer-generated report if your facility has a report that is required to be completed.

 

A few tips to remember with this app, first and foremost, please make sure to lock your iPad with a passcode.  This helps to ensure the privacy of the information that has been saved on your app and also helps to protect your valuable information that is stored on your iPad, should someone “borrow” it.  Also, please remember that this is a work in progress.  This app will continue to have new feature added.  One feature that will soon be added is the cranial nerve assessment section.   Please write a review of the app.  This is how we as the authors and Smarty Ears will know how to improve the app so that it can be useful for everyone.

 

We hope you enjoy Dysphagia2Go!!

 

Dysphagia2Go can be found on the app store for iPad at: http://itunes.apple.com/us/app/dysphagia2go/id469925526?mt=8

 

Dysphagia2Go is a revolutionary app connecting the dysphagia assessment world to technology. Dysphagia2Go offers an easy to use, HIPPA compliant** resource to complement your Clinical Dysphagia Evaluation. Dysphagia2Go guides you through the evaluation process with reminders to assess medications, cranial nerves and all the areas on which any good dysphagia evaluation should focus. This app provides a thorough evaluation report template developed by speech pathologists who have drawn upon their experience in varied settings to provide extensive opportunities to record chart reviews, assessment data, and recommendations in a single document, which can then be printed or e-mailed directly from the user’s iPad.

 

Dysphagia2Go allows for easy, single touch evaluation results with an easy-to-print report. If you don’t find what you need on the app or have other comments that should be added, Dysphagia2Go offers comment boxes throughout to add your own evaluation information.

 

Drop the pen and paper during your dysphagia app and use Dysphagia2Go for a quick and easy, complete Clinical Dysphagia Evaluation. While Dysphagia2Go provides an excellent resource for reporting data for swallowing assessments performed by a speech and language pathologist, it is NOT intended to replace an SLP’s clinical expertise or consultation. This app is not a replacement for clinical training and should not be used by individuals who are not experienced licensed speech and language pathologists.

 

* Dysphagia2Go relies on security measures that are built-in on the iPad.

** The app can only comply with HIPAA standards if user is protecting iPad data using iPad’s password protection.

*** Smarty Ears, LLC is not responsible for maintaining the confidential information that users have entered in to, or sent from the Dysphagia2Go app.

**** Smarty Ears, LLC does not recommend that the information entered in the application be e-mailed over a non-secure connection.