The clinician's place for dysphagia awareness, evidence-based practice and information.
The First Thing.... When I assess a patient with dysphagia, my first plan of attack is to teach the patient about oral care and start an oral care plan with that patient! Aspiration Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways, that is, the act of taking [...]
Inspiratory Muscle Strength Training Inspiratory strength training works on the muscles of inspiration the diaphragm, the intercostals. Inspiration involves contractions of the diaphragm and external intercostals, which increase intrathoracic volume and decreased volume in pressure. Respiration is a recoil from inspiration. Exhalation involves relaxation of the inhalation muscles, recruitment of abdominal and internal intercostals to force [...]
Research Research by Dr. Lazarus and Dr. Robbins has focused heavily on lingual strengthening. Many of these research articles have proven to us that lingual strengthening using resistance such as an IOPI does increase not only tongue strength and at times, tongue mass, but also improves the overall swallow. This same research has also shown us that using [...]
Way back in 2014...... Way back in 2014, an article was published describing Chin Tuck Against Resistance. When we look at patients with dysphagia from Pharyngoesophageal Segment (PES) dysfunction, we look at strengthening the suprahyoid muscles. These muscles assist in hyolaryngeal excursion and therefore play a part in esophageal opening. Isokinetic vs. Isometric CTAR vs [...]
The 1998 Paper Leder, Cohn and Moller investigated the incidence of aspiration following extubation in critically ill trauma patients. The study looked at 20 patients who required oropharyngeal intubation for at least 48 hours. All FEES were completed around 24 hours following extubation. Remember, aspiration is when the bolus enters the airway, below the level [...]
The many colors of FEES You've maybe witnessed a FEES exam. It can sometimes be quite colorful. Often, green food coloring is used during the exam. This helps to make the bolus "stand out" in the pharynx. You may also see blue food coloring used or even white food coloring or naturally white foods such [...]
You know about FEES.... You've more than likely heard about FEES (Flexible Endoscopic Evaluation of Swallowing) by this time. If not, take a look around this blog because I have been blogging about FEES all month! But have you heard about FEEST? Have you heard of FEEST? Flexible Endoscopic Evaluation of Swallowing with Sensory Testing [...]
MBSS VS. FEES Whenever you read the literature, you often see MBSS vs. FEES or a similar thought comparing the two tests, attempting to find the superior, gold standard assessment. On social media, we seem to have 2 camps. Team MBSS and Team FEES. You can't be friends and in separate camps!! (Completely joking here!!!) [...]
You don't use FEES. Maybe you don't believe in FEES because you've heard somewhere that it's dangerous. Myth #3........FEES is too dangerous for my patients. I'm pretty sure that if FEES were that dangerous, it wouldn't still be a thing. I mean, if we're doing harm to patients with use of a procedure, it would [...]
This is going to be a big one. This is going to maybe go against everything you've ever heard or known. I mean, maybe I need a drumroll here...... FEES Myth #2 Busted......... You CAN see aspiration with FEES. There.....i said it. "Good agreement was found, especially for the finding of aspiration (90%)." (Regarding FEES) [...]