Restorative Interventions for Dysphagia as Guided by Evidenced-Based Practice

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Learner Outcomes. Perceive why prove based practice (EBP) is so critical? Pick up proposals for blending EBP into clinical-choice making Apply a system of investigation for picking restorative mediations as they apply to the physiology of the swallow. Presentation. In a highlighted article in JAMDA, clinical neuroscientist Irene Campbell-Taylor states, \"there is no confirmation to bolster the su

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Helpful Interventions for Dysphagia as Guided by Evidenced-Based Practice Debra Tarakofsky, M. S., CCC-SLP Michelle Kravatsky, M. S., CCC-SLP Frederick DiCarlo, Ed.D, CCC-SLP

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Learner Outcomes Recognize why prove based practice (EBP) is so imperative? Pick up recommendations for consolidating EBP into clinical-basic leadership Apply a structure of examination for picking remedial intercessions as they apply to the physiology of the swallow

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INTRODUCTION In an included article in JAMDA, clinical neuroscientist Irene Campbell-Taylor states, "there is no proof to bolster the proposed requirement for such administration [of gulping impairment]" and that "the lion's share of SLPs and other united wellbeing experts occupied with the administration of OPD [oropharyngeal dysphagia] are deficiently trained." The assault revitalized ASHA and individuals from Special Interest Division 13, Swallowing and Swallowing Disorders, to counter a clearing derision of the estimation of dysphagia mediation and the preparation of SLPs. An aggregate of 14 writers created and presented an article, "Oropharyngeal Dysphagia Assessment and Treatment Efficacy: Setting the Record Straight," to JAMDA .

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Response re: utilization of MBS For the situation of pharyngeal stage irregularities which incorporate such debilitations as deficient aviation route security or fragmented and wasteful transport of material through the pharynx … the videofluoroscopy gives an immediate chance to assess the viability of compensatory moves that may lessen the effect of these anomalies on aviation route insurance … The dangers of actualizing dysphagia mediations without instrumented exhibit of useful impact are progressively perceived in administrative reports. Oropharyngeal Dysphagia Assessment and Treatment Efficacy: Setting the record straight because of Campbell-Taylor (Coyle et al., 2009)

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Additional Support "Why is an instrumental assessment of gulping required? (Swigert, 2007, going with CD-Materials for Education Staff/Physicians) * "A Bedside Clinical Evaluation is a careful appraisal of oral stage issue. However for clutters of the pharyngeal stage " * "the Bedside Clinical Exam is inadequate and fills in as a screening … " * "The instrumental symptomatic assessment is pivotal in figuring out which treatment procedures are required ." If these are Swigert cites they require a page # for instance (Swigert, 2007, going with CD-Materials for Education Staff/Physicians )

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Understanding the basic physiology of the disarranged swallow must be the benchmark from which you build up your treatment program Miller and Groher (1992) showed … get comfortable with the clinical pathologic system of certain malady forms (p.197). … incorporate a careful comprehension of consequences for the neuromuscular framework, clinical course and expected forecast The connection of these elements ought to decide the best possible way to deal with treatment (p.197) Swigert (2007) showed The assessment must incorporate data about the physiological reason for the side effects (p.101) … the indication may have more than one physiological cause. (p. 102)

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MBS Example – Case History 87 yo female admitted to the clinic with shortness of breath and Pneumonia with a background marked by Bronchitis, Anxiety, Coronary Artery Disease, and Myocardial Infarction. Pt was devouring a general eating regimen with thin fluids preceding affirmation and was downsized to Puree/Nectar after she is seen to hack irregularly with and without PO. On clinical examination she is found to have lessened lingual quality with ROM and coordination WFL. Labial quality, ROM and Coordination are WFL. Velar height and withdrawal are judged to be WFL. Laryngeal Elevation seems decreased. to the

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The Ugly Swallow VIDEO With Suggestions

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Evidence-Based Practice (EBP) Defined "… the principled, express, and sensible utilization of ebb and flow best confirmation in settling on choices about the care of individual patients… [by] coordinating individual clinical ability with the best accessible outside clinical proof from deliberate research" (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71).

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Why is EBP so Important? Clinicians should have the capacity to utilize adequacy and result information (American Speech-Language-Hearing Association, 2005; Dollaghan, 2004) Clinicians should be responsible to customers, families and outsider payers for the administrations they give (Apel, & Self, 2003) ASHA Code of Ethics manages that SLPs and audiologists must give benefits that depend on expert and watchful basic leadership (Apel, & Self, 2003)

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ASHA STATES When Evaluating Any Treatment Procedure, Product, or Program Ask Yourself the Following Questions (ASHA, 2009) What are the expressed employments? To which populace does it apply? Are results with supporting information obviously expressed?

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Levels of Evidence Classification 1A: Meta-examination 1: Well outlined randomized controlled 2: Well-planned non-randomized controlled 3: Observational reviews with controls 4: Observational reviews without controls (ASHA, 2004a)

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SLPs and audiologists can make clinical practice confirm based by: Recognizing components of people and families, and coordinating those elements alongside aptitude and research prove Acquiring and keeping up abilities identified with EBP vital in giving top notch mind Evaluating and utilizing symptomatic, screening, and aversion convention in view of EBP writing Evaluating and utilizing treatment conventions in light of EBP writing Evaluating the nature of confirmation showing up in the writing Continuing to secure and consolidate top notch EBP into clinical practice (ASHA, 2005)

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Dispelled Myths in regards to EBP The main satisfactory reason for settling on a clinical choice is from proof that is found from orderly research Clinicians are required to survey all the writing in scan for the most elevated quality logical confirmation Only people who have finished years of particular preparing can basically assess the outcomes from research (Dollaghan, 2004, April 13)

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Putting it all together

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Lingual Strengthening Exercises "The tongue assumes a noteworthy part in drive of the bolus of sustenance or fluid through the oral hole or pharynx" (Lazarus , 2005, p.2) Oral stage gulping debilitations have been seen in various patient populaces including the neurologically disabled who frequently exhibit weakness in tongue quality (Lazarus , 2005 ) (This is a rundown of her)

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Lingual Strengthening Exercises TYPE: Resistance Exercises, IOPI Robbins et al. (2007) in Archives of PM&R Lazarus (2005) in Perspectives HOW TO: Traditional tongue practices conflicting with resistance USE: Deficits of bolus control and freedom OUTCOMES: Strength increments fundamentally with resistive activities

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Example 1 Video

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Example 2 Video

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Example 3 Video

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Thoughts LSVT

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Effortful Swallow USE: To diminish buildup in the valleculae and on the base of tongue created by decreased lingual and base of tongue quality bringing about lessened oral and upper pharyngeal weight How to play out: The pt. is told to push their tongue hard against their sense of taste and swallow as hard as they can Outcomes: This strategy can be utilized as a pay amid a dinner to diminish valleculae buildup and its viability can be seen amid the assessment. It can likewise be utilized amid treatment to build BOT quality and enhance early onset of pharyngeal weights. (Swigert, 2007 pg. 135)

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Example 1 Video

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Example 2

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Example 3 Video

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Thoughts One subject in a review by Garcia et al. (as refered to in Swigert, 2007), created timing issues with nasal reverse.

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Masako Maneuver USE: To expand back pharyngeal divider development by limiting the base of tongue. Step by step instructions to Perform: Ask the pt. to distend his tongue marginally and hold it between his teeth while he swallows (Complete with spit just) Outcomes: Use of the move restoratively may bring about expanded lump of the back pharyngeal divider taking into account expanded weight at the intersection of the BOT and pharyngeal divider. Swigert 2007 p.(130)

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Example 1

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Example 2

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Example 3

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Thoughts Doeltgen (2009) [need this article for your reference list] in the AJSLP Evaluation of manometric measures amid tongue hold swallows On fluoroscopy-Increased valleculae buildups, lessened aviation route conclusion times and expanded pharyngeal postpone times when performed

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Esophageal Dysphagia ASHA (2004b) in there Guidelines for SLP's performing VFSS The standard VFSS commonly sees bolus spill out of the oral depression to the cervical throat. The part of the SLP … .. Incorporates distinguishing scatters of the … oral, pharyngeal and cervical esophageal districts. Clinicians ought to know that oropharyngeal gulping capacity is frequently adjusted in Patients with esophageal motility issue and dysphagia. … . the SLP ought to perceive the requirement for an expanded VFSS with an esophageal screening

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Esophageal Dysphagia ASHA (2004b) [need this article or reference for your list] in there Guidelines for SLP's performing VFSS A fundamental comprehension of oropharyngeal and esophageal gulping connections will permit the clinician to give ideal administrations, in this way diminishing the hazard that hidden reasons for a patient's dysphagia will go undetected amid an examination. The SLP assumes an essential part in tending to all parts of the patient's dysphagia. Likewise with any part of dysphagia administration the group