[Dysphagia] Qualifications

[eripley at yahoo.com (Irene Campbell-Taylor)]

  Recently, I have had a number of personal messages about my own background and training as well as requests for suggestions as to a method for upgrading skills and knowledge. I will answer these questions here. 
  The ASHA position paper is my basis and excerpts serve to illustrate my points:
   ?American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders. ASHA Supplement 22, 81?88.
  Recognizing the significant potential impact of swallowing and feeding disorders on overall health and quality of life, it  is essential that speech-language pathologists possess the knowledge and skills to be proficient in their management of these disorders.
  Basic Competencies
  The purpose of this document is to outline the knowledge and skills needed by speech-language
  pathologists providing services to individuals with swallowing and/or feeding disorders. These knowledge
  and skill areas form the basis for assessing clinical competency in this specialized area of practice. ?
  *** These are BASIC skills and knowledge ? please note, not ADVANCED.
  In addition, speech-language pathologists assessing individuals with potential swallowing and/or feeding disorders and providing treatment to individuals with such disorders should have a basic understanding of the following:
   
  ? Normal and abnormal anatomy and physiology related to swallowing function.
  *** This implies a knowledge of basic gross anatomy, physiology, neuroanatomy, neurophysiology, pulmonary function, gastroesophageal function, and on and on.
  Please remember, these are described as being  BASIC competencies.
   
  ? Indications for, and procedures involved with, instrumental techniques used to assist in diagnosis and management.
  *** Please note that instrumental techniques ?assist? in diagnosis ? they never ?diagnose? by themselves. The most important part of any diagnosis is the patient?s history, followed by examination and THEN appropriate instrumental  examinations. VFSS is not always either appropriate or necessary.
   
  ? Understanding of medical issues related to swallowing and feeding disorders.
  *** Probably the most important aspect of all. Without a background in basic sciences and medical, clinical
  aspects or a very intensive learning process, this is not possible. 
   
  1.c. Knowledge of nutritional intake methods (oral and nonoral) and the problems associated with each that may contribute to dysphagia or be exacerbated by dysphagia;
  *** The major problems associated with, for example, NG and PEG feeding.
   
  .d. Knowledge of signs and symptoms of swallowing and/or feeding disorders in the individual?s behavior, medical history, and medical status;
  *** While there can be no ?symptoms? of a symptom (dysphagia) it is correct that the patient?s history and current medical status must be understood.  This means understanding the effects of GI, cardiopulmonary, immune, oncological, and many other disorders as well as the exact nature of the patient?s nutrition/hydration status.
   
  1.f. Knowledge of assessment strategies for use with individuals with swallowing and/or feeding disorders.
  *** I would suggest knowledge of a full and complete clinical examination including cranial nerves, extraocular movements etc.
   
  Skills:
  1.1 Recognize signs and symptoms of swallowing and feeding disorders;
  *** Such as certain extraocular movements mentioned above as well as voice, respiratory abnormalities, gait etc. etc.
  .
  2.0 Role: Conduct a clinical examination of the upper aerodigestive tract.
  *** See above.
   
  2.f. Knowledge of any special medical condition (e.g., pulmonary dysfunction, tracheostomy,
  neuromotor involvement) that may have an impact on an individual?s feeding and swallowing.
  *** See above.
  Skills:
  2.1 Identify abnormal structure;
  *** How many look inside the mouth and inspect the roof of the mouth as well as dentition?
   
  2.3 Identify significant signs, symptoms,medical conditions, and medications pertinent
  to dysphagia;
  ** This alone requires extensive study.
   
  2.4 Conduct an oral, pharyngeal, laryngeal,and respiratory function/expiration examination as it relates to functional assessment of swallowing and feeding;
  *** It is difficult to know exactly what this means. Everyone should be able to perform an auscultatory examination of the lungs but is that what is meant?
   
  3.b. Knowledge of the variability of normal swallowing behaviors (e.g., bolus volume,viscosity, age, or gender);
  *** How many are taught that there are gender differences? Age differences ? in NORMAL swallowing?
   
  One could go on ad nauseam but I think the problems are clear.
  Now the solution, and few are going to like what I have to say, but then, what else is new?
  This is a field that should be a post graduate area of study all by itself leading to a PhD in a specific area ? pediatric, geriatric, brain injury and so on. There is no other way to ensure possession of the skills and knowledge that ASHA takes the position that everyone needs to have.
  If anyone else can suggest an equally comprehensive process, I would like to hear it.


Dr I Campbell-Taylor
Clinical Neuroscientist
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