American Speech-Language-Hearing Association

Health Care & Business Institute

Session Descriptions

Unless otherwise noted, the instructional level for all sessions is intermediate and assumes familiarity with foundational professional knowledge and terminology.

Sessions are organized into five tracks:

Opening Plenary

PL01 - The Secrets They Won't Tell You: What Makes the Top 2% Speech-Language Pathologists Successful
Linda Talley, PhD

How do you leverage your leadership style, communicate with staff, and develop your organizational culture? By understanding the psychological principles of leader development! This program provides a pragmatic approach to leadership, with innovative ways of leading and thriving in spite of the exponential change occurring in health care. We will spell out the mindset and skills required to compete in today's turbulent environment. Applying and integrating this information will enhance your capacity for innovative leadership during uncertain times. Leadership is a process that involves change and effort, and this program will enhance your ability to self-manage and lead others.

After completing this session, you will be able to:

  • align the leader's verbal and nonverbal communication to create credibility and consistency in every message delivered
  • increase levels of ownership and accountability of communication for desired results
  • build a stronger sense of purpose, ethics, and direction when dealing with staff
  • build stronger, more productive team relationships
  • lead change, manage crisis, and inspire others to do the same through using key leadership approaches and decision-making styles
  • improve communication and staff/customer relations skills, employed to engage and gain employee commitment

Business Management and Reimbursement

BMR1 - HIPAA: What Health Information Needs Securing and How to Secure It
Laurie Alban Havens, MA

The HIPAA final rule, effective as of September 2013, offers greater protection for the individual. But it also means that the provider must take greater measures to ensure the privacy and security of protected health information (PHI). We will conduct a risk analysis and, as a result of the analysis, determine information that needs to be secured. Scenarios and case studies of information-sharing/leakage are provided for discussion so that participants can determine how best to secure their clients' PHI.

After completing this session, you will be able to:

  • distinguish between privacy and security rules
  • identify categories of identifiable health information
  • identify examples of harm that would result in a financial penalty

BMR2 - The Road Ahead: Medicaid for Children in 2014
Laurie Alban Havens, MA

This session covers services provided (mostly) to children and paid for by third-party payers, including Medicaid and private insurance. It will provide a quick refresher on some Medicaid basics; changes to Medicaid in 2014, with specific attention to changes occurring as part of the Affordable Care Act; changes in procedures and diagnosis coding; and opportunities (aka challenges) in obtaining coverage for services rendered, including recommendations and approaches for appealing denied services.

After completing this session, you will be able to:

  • identify coverage categories for the new Medicaid expansion population
  • identify coding changes for pediatric services
  • identify at least two techniques used to advocate (and appeal) for speech-language services

BMR3 - Risk Management 101: Protecting Your Practice
Paul J. Welk, JD, PT

This session will provide an overview of numerous business risks encountered by rehabilitation providers during day-to-day operations. A number of common risks will be identified, and selected risk management strategies and processes will be reviewed. Specific attention will be paid to risk management issues associated with HIPAA compliance and compliance with federal healthcare fraud and abuse laws and regulations. Upon completing of this session, participants will be able to better identify key risk issues and apply appropriate strategies to mitigate such identified risks.

After completing this session, you will be able to:

  • describe the concept of risk management and identify certain key risk issues applicable to rehabilitation practices
  • explain certain risk mitigation processes and the benefits of utilizing such processes
  • identify key risk areas under HIPAA and federal healthcare fraud and abuse laws and regulations so as to better mitigate risk in these areas

BMR4 - The Ins and Outs of Contracting With Employees, Independent Contractors, and Other Third Parties
Paul J. Welk, JD, PT

This session provides an overview of general contracting principles with specific concentration on employment agreements, independent contractor agreements, and other third-party agreements. We will discuss the risks and benefits of a number of key contractual provisions. In addition, we will touch upon considerations for negotiating third-party payer agreements. Upon completion of this session, participants will be able to better identify key issues in a variety of contracts to protect their respective interests.

After completing this session, you will be able to:

  • describe the potential risks and benefits of utilizing employment agreements and independent contractor agreements
  • explain the potential risks and benefits of certain provisions of employment contracts, independent contractor agreements, and other third-party agreements
  • describe certain contracting considerations and their relationship to day-to-day business operations

BMR5 - Building a Successful Business: Candid Stories and Lessons Learned From an Entrepreneur
Adele Cehrs

Like many SLPs who founded-or plan to establish-their own private practice, Adele Cehrs of Epic PR Group was born with the entrepreneurial gene. With the tenacity and strong will to start her own company, she learned-through trial and error-how to build and grow a successful business. Adele will share candid stories from her journey and highlight the 10 most important strategies that propelled her company forward.

Attendees will be encouraged to share their personal experiences, business milestones, and challenges. Adele will weigh in, provide commentary, and teach marketing and positioning techniques.

After completing this session, you will be able to:

  • use practical techniques to create a brand promise, establish a sales process, and identify a market differentiator
  • identify the components and impact of a marketing plan and how the plan fits into a larger business plan
  • recognize what business strategies to adopt and what business mistakes to avoid

BMR6 - Keeping Up to Date: 2014 Billing Procedures and Codes for SLPs
Dee Adams Nikjeh, PhD, CCC-SLP

Billing efficiently for SLP services is challenging, especially in a rapidly changing health care environment. Receiving equitable reimbursement for services requires an understanding of the latest procedural (Current Procedural Terminology) and diagnostic (International Classification of Diseases) health care coding systems. Procedure descriptions and rationales for use of the four new SLP evaluation CPT codes that replaced CPT 92506 are presented. All revalued SLP procedure codes are reviewed so that SLPs may see the available CPT codes options. Other significant issues for discussion include defining professional skilled treatment versus unskilled services and the new ICD-10 coding system.

After completing this session, you will be able to:

  • list the four new speech-language pathology procedure evaluation codes (CPT codes) that replace CPT 92506
  • describe how to appropriately use the four new SLP evaluation CPT codes
  • list three existing SLP evaluation procedure codes appropriate for use with adult patients
  • differentiate between professional decision-making and unskilled services

BMR7 - Dollars and Sense: Voice Evaluation and Management Reimbursement Issues
Dee Adams Nikjeh, PhD, CCC-SLP

SLPs who provide behavioral and qualitative voice evaluation, instrumental assessments, and management of related voice disorders have unique coding and claims issues. Billing appropriately and efficiently requires thorough knowledge and specific application of current health care coding systems (e.g., Current Procedural Terminology and International Classification of Diseases). We will discuss implications for the new voice and resonance evaluation procedure. Significant issues, such as which procedure codes can and cannot be combined on the same day and how to use coding modifiers and edits, will be explored. Active audience participation is encouraged, and coding scenarios specific to voice evaluation and management are presented for discussion.

After completing this session, you will be able to:

  • describe the rationale for and use of the new voice and resonance evaluation procedure code that replaces CPT 92506
  • describe how to use coding edits and modifiers when billing for instrumental assessments and behavioral evaluation on the same date of service
  • participate in an active exchange of questions and answers related to coding and reimbursement issues specific to voice and related disorders

BMR8 - The Affordable Care Act (ACA) Era: Will Your Program Take a Dive, Barely Survive, or Thrive? It's All Up to You! Part 1
Ann Kummer, PhD, CCC-SLP

The Affordable Care Act (ACA) will dramatically change the way health care is provided in the United States. All providers will be charged with achieving the triple aim of improving the patient/family experience (e.g., increasing quality and satisfaction), improving the health of populations, and reducing per capita cost of care. In Part I of this seminar, we will examine strategies to treat our patients by delivering services that improve the functional outcomes most important to them. Additionally, we will review strategies on how we can improve communication health for various populations.

After completing this session, you will be able to:

  • describe the basic changes in reimbursement that will occur as a result of the ACA and how these changes will affect the practice of speech-language pathology
  • list and discuss several strategies to improve the outcomes of our treatment and increase patient/family satisfaction
  • describe ways of improving communication health for specific populations

BMR9 - The Affordable Care Act (ACA) Era: Will Your Program Take a Dive, Barely Survive, or Thrive? It's All Up to You! Part 2
Ann Kummer, PhD, CCC-SLP

The Affordable Care Act (ACA) will dramatically change the way health care is provided in the United States. All providers will be charged with achieving the triple aim of improving the patient/family experience (e.g., increasing quality and satisfaction), improving the health of populations, and reducing the per capita cost of care. In Part II of this seminar, we will examine specific strategies to decrease the costs of service delivery. Additionally, we will review strategies to decrease the overall per capita cost of achieving functional outcomes valued by our patients.

After completing this session, you will be able to:

  • list specific strategies to decrease programmatic costs (and increase revenue) by eliminating waste, increasing efficiency, and having all SLPs work to the "top of license"
  • describe scheduling methods that will maximize progress for the patient and decrease the overall cost of achieving desired outcomes
  • discuss the use of self-management principles to increase patient/family engagement and active participation in the treatment process

Business and Technology Strategies

BTS1 - Impactful Communication Training for Professionals and Businesspersons
Everett Leiter, MPh, MBA, CCC-SLP

SLPs are in a unique position to help professionals and people in business enhance their communication skills. Possible services offered include foreign accent modification, regional and social accent modification, presentations training, sales training, listening skills, and cultural expectations of communication in the United States. This presentation discusses similarities and differences between speech-language therapy and communication training for adults who have no disorders. We will also discuss how to connect with prospective clients and convert them into customers who generate a profit for our practices.

After completing this session, you will be able to:

  • distinguish between speech-language therapy and communication training in a business context
  • help clients identify aspects of communication that we can help them to enhance
  • design three communication training goals and training activities that are relevant to business and professional needs

BTS2 - It's Not What You Said! It's What You Didn't Say: The Secrets of Gestures and the Messages They Relay!
Linda Talley, PhD

Welcome to the real world: where what your internal or external customer isn't saying says so much more than what they are saying! If you want the competitive edge when it comes to influence, persuasion, and patient/client engagement, you must learn to recognize what your client's body is saying that his or her mouth is not! We read a person's body language every day, but sometimes we just don't know we're doing it. Do you know how to utilize nonverbal behavior to build relationships faster, remove barriers to engagement or create buy-in, and monitor your own body language in order to influence and persuade? If not, grab your chair, because this will be an incredible ride when you find out what your staff or clients have been saying to you, even when they haven't said a word! And you'll be stunned to learn what messages you are sending that could block the desired result or a budding relationship!

After completing this session, you will be able to:

  • identify the six positive gestures an internal/external customer makes
  • identify the six defensive gestures an internal/external customer makes
  • interpret your internal/external customer's "ready-to-buy" and "not-ready-to-buy" signals
  • identify what gestures signal deception
  • recognize how to respond to defensive gestures to turn the conversation around
  • deal with proxemics during the negotiation
  • deal with haptics during the encounter
  • make an instant connection with anyone

BTS3 - "Inside and Outside the Box:" Apps for Pediatric Populations
Sean J. Sweeney, MS, MEd, CCC-SLP

Our field has seen a recent explosion of iPad apps specifically designed for speech-language therapy in children and adolescents. This session demonstrates some of the features characteristic of the "best apps" geared toward addressing clinical objectives for school-age children. Additionally, this workshop will model therapeutic "repurposing" of apps designed for gaming, visual exploration, creative organization, and other uses for SLPs. Participants will gain resources for further learning about app integration.

After completing this session, you will be able to:

  • identify exemplars and useful features of dedicated speech-language apps for children
  • apply criteria for selecting apps useful in addressing clinical objectives
  • identify sources of information valuable in making informed judgments regarding app selection

BTS4 - Tech Up: Selecting Resources to Promote Efficiency and Engagement in Your Practice
Sean J. Sweeney, MS, MEd, CCC-SLP

This presentation provides an overview of current technologies useful to clinicians involved in private practice settings. The session focuses on understanding the range and specifications of devices that can be easily employed for visual support and client engagement in the clinical setting, including the iPad and Apple TV. Participants will also leave with knowledge of apps to promote productivity and outreach to client and family populations.

After completing this session, you will be able to:

  • describe specifications of mobile devices useful in private practice settings
  • explain the function and several uses of Apple TV for conveying information to clients and families
  • identify apps useful for productivity and engagement through social media and sharing of therapy activities

BTS5 - Adapting Your Website to a Mobile World
Tom Jelen

According to the Pew Research Center's Cell Internet Use 2013 survey, 57% of all American adults use their cell phone to access the Internet or use e-mail. The International Data Corporation projects that tablets will outsell PCs overall by 2015. It is very likely that an increasing percentage of the visits to your business or practice website are originating from a mobile device. How can you build a web presence that meets the needs of all of your site visitors without breaking your budget? Learn about the latest trends in web development to answer that question.

After completing this session, you will be able to:

  • explain the fundamentals of responsive and adaptive web design techniques
  • identify cost-effective techniques for adapting your practice or business website to an increasingly mobile landscape

BTS6 - Marketing of Speech-Language Pathology, Audiology, and Other Communication Services
Everett Leiter, MPh, MBA, CCC-SLP

Marketing is often examined only with a promotion viewpoint. This presentation discusses other, various aspects of creating services and/or products designed to meet specific consumer needs. We will consider the specific services and products SLPs offer and try to position ourselves to best match potential customers. We will also look into how to price our products so that we are a good value to our customers, while generating necessary profit. We will also examine various modes of promotion from the standpoint of cost and effectiveness. Finally, we will discuss the foundations of promotion: communicating benefits, rather than just features, to prospective customers.

After completing this session, you will be able to:

  • define a specific service/product in terms of a specific target market of prospective customers
  • form a basis for pricing services and products
  • distinguish between features and benefits in promoting at least two services or products

BTS7 - What's Your PR End Game? Learn the Critical Moves to Leverage Your Brand to Maximize ROI
Adele Cehrs

"Always begin with the end in mind." This mantra from Stephen Covey's Seven Habits of Highly Effective People has been repurposed and repeated among professional circles for years. But how does it apply to SLPs who manage private practices? Furthermore, what does it take to map out a strategy that gets to the "end" first?

An endgame is a point in time during play   when only a few critical moves remain to win. To survive and remain in demand, SLPs must first lead with their own endgame-the bottom-line, hard-hitting, business objectives-and then align those with patient benefits-not the other way around.

During the session, Adele Cehrs, the CEO of Epic PR Group and a nationally recognized speaker, will teach SLPs how to redefine and align organizational goals, staff culture, and patient satisfaction. Attendees will walk away with their own PR endgame moves in hand.

After completing this session, you will be able to:

  • better describe your practice's internal and external dialogues, stories, and initiatives through the "endgame" lens
  • assess your practice to see if it has an "endgame" mentality and learn how to create one if it's missing
  • create a formula for melding organizational goals and discipline with patient satisfaction to create a staff culture of "do-ers" to positively affect ROI

BTS8 - "Inside and Outside the Box": Apps for Adult Populations
Sean J. Sweeney, MS, MEd, CCC-SLP

The iPad can serve as a "many-in-one" therapy tool for clinicians working with adults, greatly reducing planning time and engaging clients in visual and language-based activities. This session explores the iPad as a clinical tool, modeling apps across various disorder areas and clinical tasks. Participants will gain knowledge of exemplars and features typical of apps dedicated to speech and language therapy for adults. We will also discuss evaluation criteria for repurposing apps not specifically designed for therapy but that are applicable to clinical objectives.

After completing this session, you will be able to:

  • identify clinical uses of "native" apps such as the camera, calendar, and reminders apps
  • identify exemplars and useful features of dedicated speech-language apps for adults
  • apply criteria to evaluate and "re-purpose" apps for clinical use

BTS9 - Inbound Marketing 101 for SLPs and Audiologists
Tom Jelen

The marketing landscape has evolved dramatically over the past decade. Health consumers are far more in control of the traditional "outbound" marketing messages they see than ever before. DVR, Caller ID, and Internet radio have all disrupted traditional marketing techniques. At the same time, there are growing opportunities to reach health consumers online. According to the Pew Research Center's Health Online 2013 Survey, "72% of internet users say they looked online for health information of one kind or another within the past year." Learn how you can position your practice or business to thrive in this new "inbound" marketing landscape.

After completing this session, you will be able to:

  • recognize the difference between outbound and inbound marketing
  • identify cost-effective techniques for promoting your practice or business through inbound marketing

Adult Neurogenic Disorders

AND1 - Life Participation Approaches in Aphasia
Audrey L. Holland, PhD, CCC-SLP, BC-NCD

Emerging approaches in aphasia assessment in the past 5 years are driven by demand for shortened evaluation procedures and for clinical goals that demonstrate quality. This session discusses new impairment-based measures and describes how recent research advances and concerns with the social consequences of aphasia are influencing such basic tools.

After completing this session, you will be able to:

  • describe new approaches to the assessment of aphasia
  • describe the underlying rationales of these approaches
  • evaluate the appropriateness of the assessment approaches for use in clinical/educational/research settings

AND2 - New Clinical Approaches to the Management of Aphasia
Audrey L. Holland, PhD, CCC-SLP, BC-NCD

Recent approaches address aphasia as a chronic problem that demands not only immediate clinical management, but long-term treatment as well. This awareness, coupled with the necessity of cost-containment for treatment, has resulted in greatly increased interest in group treatment for developing a better quality of life, individual treatment techniques that stress functional application and strong generalization to everyday living, and the role of technology in treatment. This session demonstrates the application of each of these areas of aphasia management, and describes programs that have interwoven the three of them together.

After completing this session, you will be able to:

  • describe programs that integrate group treatment, new approaches, and technology
  • discover at least two new or newly-modified approaches to aphasia treatment in chronic stages
  • identify techniques for helping clients to apply what they have learned in traditional formats to everyday use

AND3 - Effective Functional Assessment Strategies for Dementia
Michelle S. Bourgeois, PhD, CCC-SLP

The purpose of this session is to discuss the impact of new health care reforms on working with patients with dementia. We will outline the continuum of cognitive-communication impairments from healthy aging, MCI, to severe dementia and discuss the range of functional goals predicted to address the needs of this population. We will review functional assessment procedures and tools designed to provide the information necessary for designing treatment approaches to achieve these goals—specifically, the cognitive and language characteristics of dementia subtypes and possible treatment goals. Finally, this session will discuss procedures and tools for assessing preserved abilities and appropriate stimuli for designing effective treatments, including visual, auditory, and environmental cues.

After completing this session, you will be able to:

  • describe cognitive-communicative symptoms of dementia subtypes from normal aging to severe dementia
  • select functional assessment areas for determining preserved abilities and appropriate stimulus conditions to support potential treatment goals
  • describe the range of memory, language, and behavioral deficits amenable to visual, auditory, and environmental cueing strategies
  • write functional treatment goals for the range of behaviors displayed by persons along the dementia continuum

AND4 - Computer-Based Cognitive Rehabilitation for Adults With Brain Injury
Lyn Turkstra, PhD, CCC-SLP

Clinicians nationwide are increasingly using computer-based cognitive rehabilitation (CCR) for adults with acquired communication disorders. This presentation reviews CCR treatment evidence for adults with acquired brain injury and adults in the early stages of dementia.

After completing this session, you will be able to:

  • critique commercially available programs and platforms for computer-based cognitive rehabilitation (CCR)
  • identify potential "active" and "essential" ingredients in CCR
  • consider pros and cons of using CCR in your practice

AND5 - Assessing and Promoting Motivation in Persons With Aphasia
Michael Biel, CScD, CCC-SLP

Sustaining motivation and engagement in therapy is key to good treatment outcomes. However, many of us rely on an intuitive understanding of motivation when trying to help our clients. In this workshop, you will learn principles of motivation and engagement in therapy that can be used during the assessment and treatment of persons with aphasia.

After completing this session, you will be able to:

  • list principles that can be used to assess the motivation for treatment in persons with aphasia 
  • identify principles that can be used to promote motivation for treatment in persons with aphasia

AND6 - Using Motivational Interviewing to Help Your Clients
Michael Biel, CScD, CCC-SLP

Sustaining motivation and engagement in therapy is key to good treatment outcomes. However, many SLPs rely on an intuitive understanding of motivation when trying to help their clients. In this workshop you will learn principles of motivation and engagement in therapy that can be used during the assessment and treatment of persons with aphasia.

After completing this session, you will be able to:

  • describe principles that can be used to assess the motivation for treatment in persons with aphasia
  • describe principles that can be used to promote motivation for treatment in persons with aphasia

AND7 - Effective Functional Treatment Approaches for Dementia
Michelle S. Bourgeois, PhD, CCC-SLP

This presentation describes a range of innovative and functional cognitive-communication treatments for persons with degenerative disorders. Recent evidence-based practice reviews of effective intervention approaches have revealed a diversity of effective treatments for the range of cognitive-communication deficits of this population. We'll share and discuss protocols and details of specific treatment approaches, including visual cueing, memory strategy training, and environmental modifications. New approaches to documenting treatment outcomes will be discussed in relation to the new health care reform mandates. This session includes audience participation to stimulate positive solutions to common therapeutic and billing roadblocks.

After completing this session, you will be able to:

  • describe cognitive-communicative symptoms of dementia subtypes from normal aging to severe dementia
  • select functional assessment areas for determining preserved abilities and appropriate stimulus conditions to support potential treatment goals
  • describe the range of memory, language, and behavioral deficits amenable to visual, auditory, and environmental cueing strategies
  • write functional treatment goals for the range of behaviors displayed by persons along the dementia continuum

AND8 - Nature and Assessment of Acquired and Progressive Apraxia of Speech (AOS)
Edythe A. Strand, PhD, CCC-SLP

Apraxia of speech (AOS) occurs acutely or in the context of progressive neurologic disease. This presentation focuses on the characteristics of both forms of AOS. Emphasis is placed on differential diagnosis of the contribution of AOS versus aphasia following stroke. Because progressive AOS often occurs in the context of primary progressive aphasia, strategies for differentiating progressive aphasia from progressive apraxia of speech are also discussed. Case examples are presented via video. Research examining the relationship of progressive apraxia of speech to neuropathology is also presented.

After completing this session, you will be able to:

  • identify basic neural mechanisms involved in apraxia
  • describe behavioral characteristics of adults exhibiting acute and progressive apraxia of speech
  • list specific assessment tools and procedures
  • interpret adult responses on structural/functional exams and motor speech exams to come to a differential diagnosis regarding motor planning vs. linguistic deficits

AND9 - Treatment of Acquired and Progressive Apraxia of Speech
Edythe A. Strand, PhD, CCC-SLP

This session describes a number of treatment approaches for acquired apraxia of speech (AOS) and summarizes the literature on efficacy of treatments for AOS. Basic principles of motor learning, frequently incorporated in apraxia treatment, are reviewed with clinical examples. Like treatment strategies for other degenerative neurologic diseases, treatment strategies for progressive apraxia of speech change over time as the disease progresses. In this presentation, emphasis is placed on clinical thinking for making changes in therapeutic and compensatory approaches, as well as taking into account varying degrees of language impairment when treating AOS. Video examples are used to illustrate specific cases.

After completing this session, you will be able to:

  • describe current treatment strategies in acquired and progressive apraxia of speech
  • recognize changes in intervention type as disease progression occurs in progressive AOS
  • identify evidence for efficacy of different treatment strategies in AOS

Issues in Swallowing

IIS1 - Managing Dysphagia in Aging Adults
James L. Coyle, PhD, CCC-SLP, BCS-S

Medical SLPs managing dysphagia are members of a team of medical and surgical—not rehabilitation—specialists. The goals that medicine and surgery target are different from those that the SLP is accustomed to targeting for communication and cognitive disorders, yet we must embrace them to ensure optimal health outcomes for our patients. Physiologic and anatomic changes amplify the effects of disease over time. Learning how to consider the effects of aging and the effects of disease, and how to combine or separate them appropriately, is an essential skill for the medical SLP.

After completing this session, you will be able to:

  • describe the differences between rehabilitation goals and medical goals
  • define specific age-related changes in swallowing anatomy and physiology that are not pathological
  • define several respiratory, musculoskeletal, and sensorimotor physiologic changes associated with aging that may affect a patient who later acquires disease

IIS2 - Understanding the Relationship Between Dysphagia and the Respiratory System
James L. Coyle, PhD, CCC-SLP, BCS-S

The medical SLP managing dysphagia must understand the aerodigestive tract's (ADT's) structure and function like the back of his or her hand. As a physiologic mechanism first, the ADT is designed to accomplish two interdependent functions: swallowing, which is well covered in the SLP's education, and breathing, which is not. Understanding how lungs and the chest function, blood gas exchange, and medical report meanings is necessary to sort out our patient's dysphagia in the context of disease. This session reviews breathing mechanics and respiration, chest x-ray and laboratory reports and their meaning, and how mechanical ventilators work.

After completing this session, you will be able to:

  • describe the difference between ventilation and respiration
  • define factors that reduce the workload of breathing and facilitate gas exchange at the respiratory membrane
  • describe the locations of the five lobes of the lungs, normal values for white blood cells, and the differences between some mechanical ventilator modes

IIS3 - Dysphagia-Related Pneumonia, Pneumonia-Related Dysphagia, and Other Common Pulmonary Diseases in Adults
James L. Coyle, PhD, CCC-SLP, BCS-S

Understanding how common pulmonary diseases affect patient function gives the medical SLP insight regarding way swallowing function is altered in these disease states. Many pulmonary diseases are present in sick adults with signs and symptoms mimicking those of dysphagia. Chest imaging, laboratory, and other test reports for these diseases must be understood to ensure that dysphagia—if present—can be correctly identified as either the cause or effect of a respiratory condition. Pneumonia, a principal focus of the medical SLP, needs to be clearly and thoroughly understood to ensure accurate diagnosis of dysphagia-related pneumonia versus pneumonia-related dysphagia.

After completing this session, you will be able to:

  • describe the difference between aspiration pneumonia caused by dysphagia or by other causes, and other types of pneumonia
  • define the nature of congestive heart failure, chronic obstructive pulmonary disease, and pneumonia
  • define pleural effusions, pulmonary edema, atelectasis, and pneumothorax, and attribute them to their most likely causes based on medical record review

IIS4 - When the Cause of Dysphagia Is Not Obvious: Sorting Through Treasure and Surprises in the Medial Record
James L. Coyle, PhD, CCC-SLP, BCS-S

People can develop dysphagia as an unintended consequence of medical or surgical procedures, or due to apparently unrelated conditions. Dysphagia assessments for a patient with a primary diagnosis urosepsis or in a patient recovering from an aortic arch repair are examples of cause-and-effect scenarios that are not completely self-evident. But the links between dysphagia and these primary diagnoses are not always so far-fetched. This session reviews the sepsis syndrome's causes and outcomes and iatrogenic causes of dysphagia in adults, with a focus on attributing cause and effect to ensure accurate management.

After completing this session, you will be able to:

  • define sepsis, septicemia, and septic shock, some of their causes, and their physiologic outcomes
  • define iatrogenic conditions and list several iatrogenic risk factors for dysphagia in adults
  • describe how certain surgical and medical procedures can be related to dysphagia

IIS5 - Dysphagia Interventions: Are We Treating the Bolus, the Patient, or Something Else?
James L. Coyle, PhD, CCC-SLP, BCS-S

Research indicating the effects of dysphagia interventions is used to pinpoint how best to alleviate a swallowing impairment. Many common interventions have been found to produce beneficial or detrimental effects that the original researchers did not identify because they were not looking for them. Likewise, dysphagia interventions that we think are beneficial can have unintended and negative consequences that cause adverse medical outcomes for certain patients. This session will challenge participants to understand that mitigation, and not elimination, of risk is often the best possible goal.

After completing this session, you will be able to:

  • describe the known beneficial and potentially detrimental effects of three common compensatory swallow maneuvers
  • describe the effects of aspiration on the lung, and identify factors that may render a "water protocol" unwise
  • describe the potential detrimental health effects of thickened liquids and aspiration, and formulate balanced goals when aspiration cannot be eliminated in patients with oral diets

IIS6 - Esophageal Screening: The Essential Last Step in Your Dysphagia Evaluation
Ashli O'Rourke, MD

Evaluation of the entire upper digestive tract is essential in the proper assessment of dysphagia. The complete swallowing mechanism, from oral to esophageal stages, overlaps in both timing and function. Screening for esophageal dysphagia is the last, but fundamental, step in a complete evaluation. This session will cover the various studies that are helpful to screen for esophageal pathology (e.g., flexible endoscopic evaluation of swallowing, modified barium swallow with follow through, and/or esophagram) and how these can lead the practitioner to recommend the appropriate diagnostic tests or tests (e.g., esophagoscopy, high resolution manometry, and/or pH-impedance testing) if needed. Common causes of and treatments for esophageal dysphagia will be covered.

After completing this session, you will be able to:

  • identify common causes of esophageal dysphagia
  • describe the importance of esophageal screening as a part of an evaluation of an individual with dysphagia
  • name some appropriate diagnostic tests given certain findings on esophageal screening examination

IIS7 - Dental Perspectives on Aspiration Pneumonia Causes and Management
Ken Shay, DDS

Aspiration is a common cause of institution-acquired pneumonia. Pathogenic microorganisms colonize hard and soft tissue surfaces in the oral cavity and oropharynx. Many of these microorganisms are the targets of daily oral hygiene. The risk they pose to lung health can be substantially reduced through familiar, daily oral care practices. Saliva is an important intrinsic defense against microbial colonization. Medications and diseases that reduce salivary flow or change its composition also increase the risk of aspiration pneumonia. Management of salivary dysfunction is also an important but less readily addressed strategy for reducing the risk of aspiration pneumonia.

After completing this session, you will be able to:

  • describe the roles of teeth, soft tissues, and salivary secretions in the pathogenesis of aspiration pneumonia
  • describe techniques and products that can help reduce the risk of aspiration pneumonia by reducing oral bacterial colonization and pathogenicity

IIS8 - Organ Preservation Regimens for Head and Neck Cancer in the Era of Endoscopic Surgery
Katherine Hutcheson, PhD, CCC-SLP, BCS-S

Organ preservation regimens for head and neck cancer seek to maintain function by avoiding radical surgery and preserving critical structures of the aerodigestive tract. Organ preservation treatments are constantly changing as minimally invasive endoscopic head and neck surgery (eHNS) techniques evolve. Transoral laser microsurgery (TLMS) and transoral robotic surgery (TORS) are the primary methods of eHNS currently used in the United States. This session will review functional outcomes of these techniques with comparison to nonsurgical (radiation-based) organ preservation regimens. An evidence-based pathway for rehabilitation after eHNS will be presented for distinct tumor sites, including cancers of the oropharynx, glottis and supraglottic larynx, and hypopharynx.

After completing this session, you will be able to:

  • describe current methods of endoscopic head and neck surgery (eHNS)
  • describe functional outcomes of eHNS for distinct sites of head and neck cancer
  • implement an evidence-based program of speech and swallowing rehabilitation after eHNS for head and neck cancer

IIS9 - Radiation-Associated Dysphagia: From Prevention to Late Effects
Katherine Hutcheson, PhD, CCC-SLP, BCS-S

The incidence of head and neck cancer (HNC) is rising, and HNC survivors are living longer due to epidemiologic changes in the disease and advances in treatment. As a consequence, SLPs encounter growing numbers of patients with radiation-associated dysphagia (RAD). RAD occurs along a continuum, as an acute (early), chronic (persisting), or late (delayed) effect of therapy. This session will discuss an evidence-based approach to prevention and management of RAD across the continuum of cancer survivorship, from prevention to management of late-RAD. Recent trials on the efficacy of proactive swallowing therapy, exercise, NMES, and boot-camp in patients with RAD will be reviewed.

After completing this session, you will be able to:

  • describe how epidemiology of HNC, tumor characteristics, and therapeutic combination influence risk of radiation-associated dysphagia
  • implement an evidence-based program of proactive swallowing therapy before patients initiate radiotherapy for HNC
  • describe a multidimensional assessment paradigm for comprehensive evaluation of radiation-associated dysphagia

Pediatric Issues

PI01 - It Takes a Team: Multisystem Complexities in Novel Feeders
Joan Arvedson, PhD, CCC-SLP, BCS-S
Richard Noel, MD, PhD
Alan Silverman, PhD

Many children referred to SLPs for initial consultation present a range of feeding and swallowing problems, some of which require interdisciplinary team assessment and management. The severity of these problems is often enormous: Many of these children have no (or minimal) experience with oral feeding. Sorting out the issues to advance oral feeding requires extensive investigation into the past and current status of the airway, GI tract, nutrition, oral skills, swallowing function, and family/child interactions. We will also discuss feeding and swallowing issues relevant to SLPs and the knowledge needed to achieve desirable outcomes.

After completing this session, you will be able to:

  • describe the roles of interdisciplinary team members in decision-making for children with complex feeding and swallowing problems
  • state three implications of negative impact on oral feeding in children with delayed oral skill development
  • delineate three interrelated airway and GI tract etiologies that may delay advance of diet for children

PI02 - Aerodigestive Issues: Pharyngeal Phase Dysphagia
Joan Arvedson, PhD, CCC-SLP, BCS-S
Richard Noel, MD, PhD
Alan Silverman, PhD

A stable airway and adequately functioning digestive tract are needed for SLPs to manage children with feeding and swallowing problems. SLPs' knowledge and understanding of upper airway problems (e.g., laryngeal cleft, vocal fold paralysis, trach/vent) and digestive tract (e.g., nutrition, gastroesophageal reflux) are extensive, but instrumental swallow study information is also often important in the differential diagnoses and intervention potential. Delineation of boundaries between professions will be discussed as part of a larger assessment of team management of children with major health risks in their journey to oral feeding.

After completing this session, you will be able to:

  • state three common etiologies of upper airway obstruction with implications for impact on oral feeding
  • describe key components in nutrition needs for children with gastroesophageal reflux
  • delineate professional boundaries for care of children with medically complex conditions in light of SLP scope of practice and ethical guidelines

PI03 - Impact of Esophageal Dysphagia: What Do SLPs Need to Know?
Joan Arvedson, PhD, CCC-SLP, BCS-S
Richard Noel, MD, PhD
Alan Silverman, PhD

Esophageal deficits typically have major negative impact on interest in oral feeding that lasts from infancy through old age. Eosinophilic esophagitis (EoE), which has become more prevalent in recent years, must be identified and managed to facilitate oral feeding. Other types of food allergies and sensitivities can also be the basis for food refusals. Children communicate their physiologically based discomfort through a variety of negative behaviors that are stressful to caregivers. Outside forces often escalate these behaviors. Most of these children do not have oropharyngeal dysphagia, but may need some attention to improve their oral skills as they have missed critical and sensitive periods.

After completing this session, you will be able to:

  • state three principles of behavioral intervention for children whose primary issues relate to food refusal
  • describe dietary options for management of EoE in infants and young children
  • differentiate EoE from other causes of gastroesophageal reflux

PI04 - Putting the Pieces Together: Co-Treatments With Case Studies
Joan Arvedson, PhD, CCC-SLP, BCS-S
Richard Noel, MD, PhD
Alan Silverman, PhD

Children with persistent feeding and swallowing problems show similarities with and differences from one another. Given the multifactorial combination of issues, no single professional discipline can manage these children in isolation. Co-treatments give options for meeting the needs of children and their caregivers for an integrated approach. SLPs and psychologists who specialize in pediatric dysphagia provide unique knowledge and skills for direct interaction with children and coaching for parent-child interactions. Medical and nutrition monitoring and guidance, including by parents, are critical as a part of focus on the "whole child." The challenges and rewards will become clear in this session.

After completing this session, you will be able to:

  • list three ways that psychologists and SLPs integrate their separate scopes of practice in co-treatment sessions
  • state three reasons for failure to advance oral feeding volume and textures in young children
  • describe three types of focuses to wean young children from a gastrostomy tube

PI05 - Social Communication in Adolescents With Acquired Brain Injury
Lyn Turkstra, PhD, CCC-SLP

Pragmatic language is viewed within the broader context of social communication and is linked to current notions about social cognition. This course discusses relationships among pragmatic language, social communication, and social cognition and the practical implications of these relationships for assessment and treatment of adolescents with neurogenic communication disorders.

After completing this session, you will be able to:

  • define social cognition and relate current concepts of social cognition to pragmatic language and social communication
  • summarize current knowledge about social communication impairments in adolescents with neurogenic communication disorders
  • identify practical methods for assessment and treatment of social communication problems in adolescents with neurogenic communication disorders

PI06 - Treatment of Childhood Apraxia of Speech
Edythe A. Strand, PhD, CCC-SLP

This lecture reviews a number of basic treatment strategies for childhood apraxia of speech (CAS). Emphasis is on applying principles of motor learning in the design and administration of these therapy techniques. A summary of the evidence base is included, as well as practice in clinical thinking. Video examples of therapy strategies are provided.

After completing this session, you will be able to:

  • describe the basic principles of motor learning
  • describe a number of treatment strategies appropriate to motor planning/programming impairment
  • demonstrate clinical thinking in treatment planning

PI07 - A Closer Look at Differential Diagnosis of Childhood Apraxia of Speech
Edythe A. Strand, PhD, CCC-SLP

This session reviews basic assessment tasks, including structural functional examinations and a new dynamic assessment procedure for motor speech impairment. Emphasis is placed on interpreting assessment data to more confidently diagnose the presence and severity of childhood apraxia of speech (CAS) in children with severe speech sound disorders. Video examples are used to enhance understanding of speech characteristics in CAS. Practice in clinical thinking and examples of how to report diagnostic statements in documentation are provided.

After completing this session, you will be able to:

  • perform structural functional examinations and interpret findings relative to differentiating motor speech impairment in children
  • describe dynamic assessment and explain how motor speech examinations are important to differential diagnosis of severe speech sound disorders
  • write diagnostic statements with clarity and specificity

PI08 - Promoting Recreational Engagement in Children With ASD
Patricia Prelock, PhD, CCC-SLP

Recreation has many known benefits, most notably improved health and well-being, and is especially important for children and adolescents with ASD who experience a poorer quality of life relative to other children. Given the complex interplay of factors hindering opportunities to participate in recreation-such as challenges in social communication-this session uses the available research and case studies to describe the importance of recreation in children with ASD. We will also examine the role of speech-language pathologists in intervention as they collaborate with inter-professional colleagues to support a meaningful context for social interaction through recreational engagement.

After completing this session, you will be able to:

  • explain the benefits of recreational engagement
  • identify three factors that can hinder participation in recreation for children with ASD
  • describe two strategies to support recreational engagement in children with ASD

PI09 - Making a Difference for Individuals With Disabilities: Applying the ICF
Patricia Prelock, PhD, CCC-SLP

Speech-language pathologists and audiologists seldom have sufficient time to individualize learning opportunities for patients with communication disorders who recognize their particular stories. This session uses the International Classification of Functioning, Disability, and Health (ICF) to identify the strengths, interests, and needs of an individual and his or her family to improve communication and active participation at home, in school, and in the community. Participants will learn the value of knowing and sharing both a child and family's story to develop an intervention plan that leads to desired outcomes.

After completing this session, you will be able to:

  • explain the ICF as a framework for understanding the strengths and challenges of individuals with communication disorders
  • identify three strategies that can be integrated into the intervention plan of at least one child with a communication disorder using the ICF

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