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Session Descriptions

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Controversies and Consensus in Dysphagia Management

August 3–15, 2022 | Online Conference

These pre-recorded sessions are on-demand and last about an hour, so you can watch them whenever time permits! Taken together, sessions present differing perspectives on specific topics related to dysphagia management. 

What is a Comprehensive Assessment? (two sessions)

Clinical Swallowing Exams: Strengths and Limitations
Kendrea L. Garand, PhD, CScD, CCC-SLP, BCS-S, CBIS, CCRE

This session explores the strengths and limitations for interpreting clinical swallow examination (CSE) results, including implications for dysphagia management in adult populations across clinical settings. The speaker contrasts CSEs with instrumental swallow examinations and shares resources to maximize clinical usefulness of the clinical swallow exam.

After completing this session, you will be able to:

  • list components of a comprehensive clinical swallow examination
  • explain the limitations of a clinical swallow examination
  • contrast clinical usefulness of a clinical swallow examination with an instrumental examination

Role of Instrumental Exams in the Diagnosis and Management of Dysphagia
Rinki Varindani Desai, MS,CCC-SLP, CBIS, CDP

This session shares preferred practices for selecting, conducting, and interpreting instrumental swallow exams. The speaker discusses strengths and limitations of different instrumental exams, along with clinical applications to promote more accurate dysphagia diagnosis, targeted treatment planning, and positive patient outcomes. The session includes tips for critical thinking and current evidence supporting the use of instrumental exams to optimize the safety and quality of life of those living with swallowing disorders.

After completing this session, you will be able to:

  • list three or more benefits of using instrumental exams in the assessment of swallowing disorders Identify key differences between FEES and MBSS instrumental swallowing exams
  • describe how to plan dysphagia intervention based on physiological findings during instrumental swallow exams
  • list ways to advocate for the use of instrumental exams for individuals with suspected dysphagia

Is Imaging Objective? (two sessions)

Objectivity, Subjectivity, and Validity in Fiberoptic Endoscopic Evaluation of Swallowing
Susan E. Langmore, PhD, CCC-SLP, BCS-S; Gintas Krisciunas, MPH, MA; and Renée Speyer, PhD

Both fluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES; also known as flexible endoscopic evaluation of swallowing) are considered “gold standard” dysphagia assessment procedures. Both have their strengths and weaknesses, and clinicians using either procedure can use various objective, subjective, and/or valid assessments to determine the nature and severity of a patient’s dysphagia. This session reviews what it means for a measure to be objective, subjective, and/or valid and applies these concepts to FEES. The presenters also discuss other, equally important, criteria to consider when evaluating a patient for dysphagia: accuracy, meaningfulness, and relevancy. 

After completing this session, you will be able to:

  • interpret psychometric properties of visuo-perceptual and semi-automatic measures to judge their reliability, validity, and responsiveness
  • relate psychometrics to patient-directed outcomes of accuracy, meaningfulness, and relevancy
  • discuss requirements and processes of instrument development in FEES

Objectivity in Videofluoroscopic Swallow Studies (VFSS)
Bonnie Martin-Harris, PhD, CCC-SLP, BCS-S

Measurement scales that require a human interface are characterized by some level of subjectivity. The necessary precision of the scale depends, in part, on the clinical purpose or research question that drives the videofluoroscopic study. This session introduces technological, procedural, and analysis factors that optimize objectivity and reproducibility of clinically valid videofluorscopic measurements made from modified barium swallow (MBS) studies. The speaker addresses the importance and preferred practices for learning, training, and measurement skill calibration and demonstrates positive and negative influences of clinical bias on VFSS measurement and interpretation. The session presents the value of novel machine vision methods integrated into MBS workflow to aid measurement objectivity and reliability.

After completing this session, you will be able to:

  • explain factors that optimize objectivity, reproducibility, and validity of measurements made from VFS images
  • describe the relationship between precision and purpose of VFS measures
  • implement measurement skill calibration between SLP colleagues in clinical practices
  • explain the role of machine vision methods for computer-assisted swallowing measurements integrated into the MBS workflow

What is Most Effective in Targeting Swallow Physiology? (two sessions)​

Texture Modification and Its Impact on Swallowing Function
Catriona M. Steele, PhD, CCC-SLP

SLPs who work with people with dysphagia face the challenge of identifying food textures and liquid consistencies that will optimize swallowing safety and efficiency while minimizing negative consequences on quality of life and nutrition. This session features case-based opportunities to practice the skills involved in determining when and how texture modification can be used to improve swallowing outcomes. 

After completing this session, you will be able to:

  • compare videofluoroscopic measures of swallowing physiology of different liquid consistencies to reference values to determine which values are typical or atypical
  • explain how thickened liquids influence penetration-aspiration and related physiological parameters
  • teach a patient or caregiver how to determine the consistency of a food or liquid using standardized texture testing methods

Exercise vs. Maneuvers: Moving Dysphagia Management From Performance to Learning 
Giselle D. Carnaby, MPH, PhD

The application of multiple swallow maneuvers is often a mainstay of dysphagia intervention, but the role of the maneuver and its effect on swallow rehabilitation outcomes are not always clear. This session explores swallowing intervention beyond the application of maneuvers and reviews the role of motor learning strategies in maximizing outcomes for patients. 

After completing this session, you will be able to:

  • describe the difference between motor performance and motor learning and when to apply each approach in the rehabilitation of a patient with dysphagia 
  • compare practice strategies to enhance patients’ swallowing skills
  • discuss the timing and measurement of the blended skill/strengthening approach 

Dysphagia treatment–What is the Primary Goal? (two sessions)

Timing Is Everything: Diagnosis and Treatment of Laryngeal Vestibule Closure Impairments
Alicia Vose, PhD, CCC-SLP

Impairments in laryngeal vestibule closure (LVC) are a major cause of aspiration during swallowing. Accurately identifying LVC impairment is a priority in dysphagia management as aspiration can occur if LVC is absent or delayed, or duration is reduced. However, this mechanism is often overlooked and underreported in the evaluation of swallowing and in swallowing research. This session discusses methods for incorporating LVC as a primary outcome measure in dysphagia diagnosis and management to increase diagnostic accuracy and optimize dysphagia management. 

After completing this session, you will be able to:

  • comprehensively diagnose laryngeal vestibule closure impairments in individuals with dysphagia
  • differentially diagnose timing impairments to determine a primary swallowing pathophysiology

Is Texture Modification Appropriate for Individuals With Dysphagia?
Luis F. Riquelme, PhD, CCC-SLP, BCS-S

Modifying diet consistencies is one of the more common approaches to dysphagia care. However, much controversy remains regarding how SLPs tackle decision-making and about the actual modification and measurement of liquids and foods in terms of nutrition and safety as primary goals of dysphagia treatment. This session addresses the complexities in both processes, with a focus on achieving the best outcomes for each patient.

After completing this session, you will be able to:

  • define two different routes of nutrition
  • state two reasons to support why texture-modified diets make a difference
  • identify, outline, and revise one diet consistency decision-making procedure

Additional Topics of Controversy and Consensus (five sessions)

Normal, Safe, and Efficient Swallowing: Beyond the Semantics
Ed M. Bice, MEd, CCC-SLP; and Alicia Vose, PhD, CCC-SLP

Clinicians who practice dysphagia management can easily generate a mental image of a “normal” swallow. Frequently, words such as “unsafe,” “inefficient,” or “at-risk” accompany images of swallows that deviate from normal. This session carefully examines the complexities and pitfalls of using these types of terms with patients, families, and/or medical providers. In particular, the speakers discuss how the SLP’s notion of what constitutes safety and efficiency can influence diet recommendations and treatment plans. This session tackles the complexities of the meaning behind the words and phrases that influence and underly clinical decisions and how SLPs communicate them to patients and other stakeholders.

After completing this session, you will be able to:

  • explain the reason for using words that quantify swallowing behavior
  • describe the variability of normal swallowing
  • summarize what is known concerning safety and efficiency
  • describe aspiration pneumonia
  • distinguish between current practices and a reframed purpose

Swallowing in Patients Using High Flow Nasal Cannulas
Katie Allen, PhD, CCC-SLP

When SLPs are tasked with evaluating and treating patients who use high flow nasal cannula oxygenation systems, they may have questions about these systems’ potential impact on swallowing. This session discusses the literature on swallowing and use of high flow nasal cannulas and the implications for dysphagia evaluation and treatment. 

After completing this session, you will be able to:

  • identify basic components of high flow oxygenation systems
  • discuss points to consider when conducting a swallow evaluation with a patient using airflow via high flow nasal cannula
  • describe the relationship between use of high flow nasal cannulas and laryngeal vestibule closure in healthy individuals
  • discuss possible implications of high flow nasal cannulas on treatment

Cultural Considerations and Health Equity in Dysphagia Management
Kellyn Hall, PhD, CCC-SLP; and Leslie W. Johnson, PhD, CCC-SLP

This session explores how health disparities impact dysphagia management and associated outcomes. The speakers present tools and strategies SLPs can use to improve their cultural responsiveness and adopt an inclusive mindset in their approach to patient-centered care for patients with dysphagia.

After completing this session, you will be able to:

  • identify health disparities and barriers that may impact health outcomes of people with dysphagia in diverse populations
  • list strategies and resources for increasing cultural responsiveness in dysphagia management 
  • summarize approaches for adopting an inclusive mindset to promote culturally inclusive practices in dysphagia management

Is It Time To Discharge My Patient? 
Debra Suiter, PhD, CCC-SLP, BCS-S

Often, SLPs working with individuals with dysphagia struggle with knowing when it is appropriate to discharge their patient. The decision to discharge is multifactorial, including both patient- and clinician-driven factors. This session explores practical strategies and evidence-based practices for determining when it is appropriate to discharge a patient from dysphagia treatment.

After completing this session, you will be able to:

  • list at least three patient-based reasons for discontinuing dysphagia treatment
  • list at least three clinician-based reasons for discontinuing dysphagia treatment 
  • discuss evidence that speaks to expected timelines for clinicians and patients to see improvements in dysphagia

Clinical Considerations for Competency and Ethics in Dysphagia Management
Ed M. Bice, MEd, CCC-SLP

Ethics is an often-forgotten portion of evidence-based practice. Although not a distinct part of the triad, ethics play an important role in every decision. This session provides practical applications of the tenets of the ASHA Code of Ethics, with focus on the concept of competence.

After completing this session, you will be able to:

  • state four tenets of the ASHA Code of Ethics
  • name four components of competence and list essential areas of knowledge needed to develop it
  • summarize the role of questions in critical thinking

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