Tuesday, April 9, 2013

Review of "Dysphagia Management: A Survey of School-Based Speech-Language Pathologists in Vermont." This was written by Tiffany L. Hutchins, Katherine W. Gerety, and Moira Mulligan

This evening I read "Dysphagia Management: A Survey of School-Based Speech-Language Pathologists in Vermont." This was written by Tiffany L. Hutchins, Katherine W. Gerety, and Moira Mulligan.

First, kudos to the gradate student that did this study! Now onto the review of the study! In a nutshell this study involved a survey being sent to ASHA certified SLP's in the state of Vermont. SLP's that were not currently working in a school were instructed to disregard the study (though if an SLP had history of working in a medical setting but were currently working in a school setting they could still complete the survey.) This study had a 20% return rate. I'm going to do a quick summary of the article here so if you are interested in a more in-depth look check out the article, I have the link below.

http://lshss.asha.org/cgi/content/abstract/42/2/194.

Why are school SLPs seeing more students with feeding concerns?
"Under the Education for All Handicapped Children Act (1975), all children with disabilities are entitled to receive individualized education programs (IEP) tailored to their specific needs. Under the reauthorization of this Act, as the Individuals with Disabilities Education Improvement Act (2004), qualification for dysphagia management is now possible under the 'other health impairment' classification, as dysphagia can negatively affect overall health so as to limit students' ability to participate in and gain full access to their educational program in the least restrictive environment (Lefton-Greif & Arvedson, 2008; O'Donoghue & Dean-Claytor, 2008)."

What does ASHA say about all this?
"ASHA (2007a) provides specific guidelines for SLPs regarding the provision of swallowing and feeding services in schools. These guidelines include the following:
*Students must be safe while eating in school, which involves providing appropriate personnel, food, and procedures to minimize risks for choking and aspiration during oral feeding.
*Students must be adequately nourished and hydrated so that they can attend to and fully access the school curriculum.
*Students must be healthy (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) in order to maximize their attendance at school.
*Students must develop skills for eating efficiently during meals and snack times o that they can complete these activities with their peers safely."

All of this leads to important questions - What happens if the school SLP is not confident in their ability to serve a patient with dysphagia? What if the patient has an alternative form of feeding though there is potential to return to an oral diet with dysphagia treatment? This study does not answer these questions - *note* the study was not designed to answer these questions - but they are important nonetheless.

This study looked into general dysphagia management (personnel involved in a dysphagia case, opportunities for CEU, etc.,) and SLPs confidence in comparison to hands on experience, CEUs, etc., In summary - school based SLPs have lower confidence in treating dysphagia. This is due to several factors such as CEU opportunities and the recent incline of medically fragile students going to public schools. Instead of going to much deeper into this study I felt the best thing was to find resources of CEU opportunities and put the links below for anyone interested in pediatric dysphagia. I hope they are helpful! I see a few in Texas that have caught my eye!

http://www.mealtimestories.com/index.php?option=com_content&view=article&id=33&Itemid=39

http://www.asha.org/eweb/ashadynamicpage.aspx?site=ashacms&webcode=courselist&sortorder=end%20date%20in%20ascending%20order&recordcount=500

http://www.speechpathology.com/slp-ceus/course/pediatric-dysphagia-the-basics-3848

How do you feel about pediatric dysphagia? Are you confident in your abilities? How often do you work with a student with dysphagia?



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