ASHA's Letter to the Editor of the Journal of the American Medical Directors' Association (JAMDA)

January 2009

The American Speech-Language-Hearing Association (ASHA) takes great issue with Oropharyngeal Dysphagia in Long-Term Care: Misperceptions of Treatment Efficacy by Irene Campbell-Taylor, MB, ChB, PhD (JAMDA September 2008).

The author appears to have chosen a pre-determined route to a sweeping and unfair condemnation of the speech-language pathology profession-"the majority of SLPs...engaged in OPD are inadequately trained" (p. 539)-one that is lined with misrepresentations. Among the most glaring: highlighting a "recommended outline for the examination of swallowing by the American-Speech-Language Hearing Association" (p.525) as though she is referring to guidance for speech-language pathologists. The problem is that what Campbell-Taylor referenced is directed at consumers. Since her article indicates that she had access to ASHA's dysphagia documents for professionals, one has to wonder why she chose to not only make such a misleading point, but also to highlight it.

It is important to note, too, aspects of Oropharyngeal Dysphagia in Long-Term Care that are far subtler but just as troubling. For example, Campbell-Taylor cited the most recent research on dysphagia, a multi-year randomized clinical trial that was conducted by speech-language pathologists under the auspices of an ASHA affiliate, the Communication Sciences and Disorders Research Group (CSDRG). That research remains the most extensive of its kind. However, instead of acknowledging speech-language pathology for having a role in grounding dysphagia care in research, Campbell-Taylor chose instead to discredit the profession in her article.

In doing so, she failed to report on an ever developing and expanding dynamic within speech-language pathology that is readily apparent to interested parties, and which holds tremendous promise for future SLP dysphagia care. At ASHA, that dynamic is reflected by initiatives like its aforementioned policy documents, its foundation grants for dysphagia research, its special interest division on swallowing, its professional education offerings, its information sharing through its scientific journals, its regular updating of professional certification standards, and its fostering of responsible dialogue among its members for the sake of advancing the research and practice of dysphagia care.

These efforts occur because of the active participation, hard work, and commitment of many SLPs. The commonality that links them is a strong, fundamental interest in having the benefit of thoughtful, well-grounded professional guidance in order to deliver the best care possible. It is unfortunate that an approach that encompassed such very relevant realities was not taken in Oropharyngeal Dysphagia in Long-Term Care. Not only would it have been the fairer, more reasonable, and more accurate choice, but it also would have been a better and more responsible way to inform your readers.

Sincerely,

Catherine Gottfred
President