[Dysphagia] Qualifications

[bjm at francomm.com (Barbara Morrison)]

I have been following this thread on Qualifications almost daily. Irene IS
the one
who initiated the qualifications debate by personally analyzing ASHA's stand
on dysphagia
experience that an SLP should have. I have attached her original post---just
in case you
missed it. Before everyone is so quick to defend Irene (which she can
adequately do on her own),
let us not forget that she is one of the main sources who starts
controversial subjects on this listserve.
I do not think this has been a useless thread.......it is a venue for varied
disciplines to express
their opinions, this one happened to be on dysphagia qualifications.


----- Original Message ----- 
From: <chcky619@bellsouth.net>
To: <dysphagia@b9.com>
Sent: Sunday, March 12, 2006 3:56 PM
Subject: [Dysphagia] Re: Dysphagia Digest, Vol 28, Issue 17


>   I am fairly sure that I fell off the turnip truck sometime last week.  I
> cannot understand why--for one solid week this listserve has expended
energy
> to debate what is not a venue to debate.  All of the verbal garbage was
> borne out of someone's ignorant inquisition related to Irene.  If I had
half
> the integrity and active brain cells she has, I could have hung the moon.
> We insure our integrity by continuing education and the watchful eye of
> ASHA.  Life hands us lemons and we make lemonade.  Shouldn't we move on?
> Patti, SLP

Post on 3/6/06

 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
Exclusive Distributor: