Published on August 9th, 20130
Fourth International Course on Oropharyngeal DysphagiaBy Judy Schmidbauer, MA, S-LP(C), CCC-SLP, SAC Board of Directors, Director from Nova Scotia This article has been republished from the Summer 2013 issue of Communiqué. Please note that this article was originally published when Speech-Language and Audiology Canada (SAC) was called the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA).
“Connecting to Impact Dysphagia Management”
CASLPA was invited to participate at the Fourth International Course on Oropharyngeal Dysphagia – “Connecting to Impact Dysphagia Management” and I was pleased to have the opportunity to represent CASLPA. I admit I entered the course with a sense of anticipation … 29 speakers from across five continents, including speech-language pathologists, physicians, dietitians, nurses, an occupational therapist and a sociologist. A global perspective from a score of disciplines.
At the end of the two days, I was confronted with a set of emotions: overwhelmed at the breadth, quality and depth of the presentations, excited by the information that could be used clinically, inspired by a patient who wouldn’t give up and frontline clinicians who are incorporating research into their daily practices.
Given the limitations of this space, I am unable to even begin to summarize all the presentations given. I will, however, mention two of the presentations that stood out for me as a clinician— both were clinically-based research projects, done with mentorship from an experienced researcher (Catriona Steele, S-LP(C)).
Roger Ebert’s Blog, Chicago Sun Times, 07.06.10:
“Isn’t it sad to be unable to eat or drink?… What I miss is the society. Lunch and dinner are the two occasions when we most easily meet with friends and family. They’re the first way we experience places far from home. Where we sit to regard the passing parade. How we learn indirectly of other cultures. When we feel good together. Meals are when we get a lot of our talking done – probably most of our recreational talking. That’s what I miss.”
With funding from a CASLPA Research Grant, Stephen Fraser, S-LP, (Hamilton, ON), queried the effect of chin down posture on the rates of aspiration and penetration in two adult populations (CVA and general internal medicine population) for thin fluids by tsp. and cup. The results will surprise you. Read about it here.
Caren Carlaw, S-LP(C), (Vancouver, BC) discussed the free water protocol developed at their rehabilitation centre, which not only improved the fluid intake in the experimental subjects but also improved the subject scores for fear and symptom reported on the SWAL QOL questionnaire. Her study can be found here.
The presentation that had the most profound impact on me was done by a 39-year-old patient who had experienced profound dysphagia subsequent to a brain injury. As she related her journey from the beginning — “All I wanted was a sip of water. It was tortuous.” — to the end, where she achieved secretion management and a meal at her favorite fast food restaurant, I couldn’t help but marvel at the level of persistence, hard work and support that made it possible. Through 2.5 years of acute, rehab and outpatient treatment and home programming, she and her clinicians achieved their goals.
There were a series of challenges that stood out to me at the end of the meetings that I would like to share:
- To clinicians: we must not simply identify aspiration and penetration, but determine and treat the underlying causes. Our goals must be patient focused, intent on preserving the best quality of life possible.
- To researchers: more evidence-based research is needed, research that translates practically to daily clinical use.
- To academics: dysphagia training needs to be standardized, with key competencies identified.
- To students and clinicians: evidence-based research is needed. Find a mentor. Research can be done in your clinical environments. Continue to learn. Attend the dysphagia research meetings. Subscribe to Dysphagia, the journal. Keep your practices current.
- To all team members: collaborate, collaborate, collaborate. In as much as dysphagia is a global issue impacting the social, economic, physical and psychological parameters of our patients’ lives, so must our work bring together all disciplines to achieve the best quality of life possible for our patients.
Judy Schmidbauer, MA, S-LP(C), CCC-SLP
SAC Board of Directors, Director from Nova Scotia