[Dysphagia] Qualifications

[nando11504 at hotmail.com (nando poppy)]

after reading everyone's input i have my own issues about qualifications.  i 
feel that i am qualified in working with dysphagia, but some clinicians may 
be stronger in A/P versus others.  what makes this conversation confusing is 
much of the research conflicts with itself.  there is so much discrepancy on 
what works versus what does not work, it makes it difficult to truly 
pinpoint compentency.  does oral motor work or not?  does thermal stim work 
or not?  do thickened liquids work or not?  this person may get pneumonia 
after aspirating but this other person may not although they share a common 
medical history (CHF, COPD, PD) etc....

i worked with a resident who had altered mental status and difficulty 
swallowing.  We did a FEES and she aspirated thin liquids and nectar but not 
honey thick.  after many conversations, we upgraded her to thin liquids and 
thus far, no pneumonia.  her mental status is somewhat better and she is 
nonambulatory.  another resident i worked with is ambulatory, regular diet, 
thin liquids, and gets pneuomina every 3-4 months.  she is alert and 
oriented x3.  FEES revealed aspiration on thin liquids only but she refuses 
to drink thickened liquids.  based on these 2 cases on the surface, you 
would think the first resident would be the one with pneumonia, not the 
second.

i believe we do our best from what we are taught, although what we are 
taught is constantly changing.

just my .02


>From: "Bassani, Heidi D Ms WRAMC-Wash DC" <Heidi.Bassani@amedd.army.mil>
>To: <HAL9600@aol.com>, <LOBSTERPAM@aol.com>, <LLORTEAU@sbgh.mb.ca>
>CC: dysphagia@b9.com
>Subject: RE: [Dysphagia] Qualifications
>Date: Tue, 7 Mar 2006 15:16:55 -0500
>
>I personally think that Speech Pathology needs to be a bit more
>compartmentalized than it is currently in this country.  The fact that
>Masters programs are teaching a huge amount of info in a short period of
>time is regrettable given the undeniable fact that many people come into
>the field with a specialty (at least in terms of adult vs. peds) in
>mind.  I hope that as we look toward a PhD (or an ScD) in SLP as
>audiology has done, this will help the matter.
>
>However, as a relatively new clinician in who has had the chance to work
>with several wonderful people who came up in programs, back in the
>day;-)that did not offer dysphagia courses, I would like to say that we
>are currently trying (as a field) to better this aspect of speech path.
>However, all the book-learnin' in the world will NOT teach you the
>clinical skills that you need to make these decisions.
>
>First and foremost, many people can pass courses and simply do not have
>the basic clinical skills to integrate that info into the real world of
>"case studies".  And no academic program will prepare you for all the
>information that you will need to practice.  They are not designed for
>that.  The purpose of the program is to gain a basis on which you build
>and understand what you are seeing and make logical informed decisions.
>The fact that some people don't or can't do that makes us no worse than
>any other field.  In addition, there are plenty of people out there who
>consider themselves "experts" who just don't know anything.
>
>I'm ranting like everyone else but perhaps it's just me...did anyone
>else completely miss the point of the original email?  Was it to create
>a basis by which all speech paths should be held in order to practice?
>I'm pretty sure there's a group that does that!  And we can argue it all
>day. Or was it to discuss Dr. Campbell-Taylor's qualifications?  I
>missed it....
>
>Heidi
>
>-----Original Message-----
>From: HAL9600@aol.com [mailto:HAL9600@aol.com]
>Sent: Tuesday, March 07, 2006 8:03 AM
>To: LOBSTERPAM@aol.com; LLORTEAU@sbgh.mb.ca
>Cc: dysphagia@b9.com
>Subject: Re: [Dysphagia] Qualifications
>
>I personally think Ph.D. in our field as entry level requirement is long
>
>overdue.  I wrote an article about 10 years ago in ASHA saying so.
>Wasn't
>popular then and I doubt it's any more popular now.  Beam me  aboard?
>
>
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