SLP 550 Dysphagia Course Information Meeting time: Wednesday 12:45-3:15 Location: Speech Lab, Cambridge Building Instructor information: Name: Ciara Leydon, PhD, CCC-SLP Location: 2-E-06, Cambridge Building Office Hours: Tuesdays 9-12 and Thursday 9-12 Other times by appointment Telephone: (203) 365-4518 Email: leydonc@sacredheart.edu Textbooks Corbin-Lewis, K., Liss, J.M. & Sciortino, K.L. (2004). Clinical Anatomy and Physiology of the Swallow Mechanism. Clifton Park, NY: Thompson Delmar Learning Morris, S.E. & Klein, M.D. (2000). Pre-feeding skills: A comprehensive resource for feeding development (2nd ed.). Tucson, AZ: Therapy Skill Builders (On reserve) Other textbooks Arvedson, J.C. & Brodsky, L. (2002). Pediatric Swallowing and Feeding (2nd ed.). San Diego, CA: Singular Publishing Group Logemann, J. (1997). Evaluation and Treatment of Swallowing Disorders (2nd ed.). Austin, TX: Pro-Ed Murry, J. (1998). Manual of Dysphagia Assessment: Assessment in adults. San Diego, CA: Singular Publishing Group Learning objectives Students will demonstrate acquisition of the basic knowledge and skills necessary to 1. identify the anatomy, physiology, and neural controls involved in normal swallowing for children and adults (ASHA Standard IV-B and V-A) 2. identify primary etiologies and associated dysphagia characteristics in children and adults (ASHA Standard IV-C, V-A and V-B) 3. identify evidence-based methods for instrumental and non-instrumental techniques for differential diagnosis of swallowing disorders (ASHA Standard IV-D, V-A and V- B)
4. devise research-supported therapy/management plans for the treatment of specific swallowing impairments, taking into account motivation level, quality of life, cultural, ethical, and moral issues (ASHA Standard IV-D, V-A and V-B) Assessment Short papers: Each student will write a paper on each of the topics listed below. Papers should be about three-page in length (double-spaced). Students should be prepared to give a concise and complete presentation of each paper in class. Describe the swallowing process (including reference to the neural, biomechanical, and respiratory aspects of swallowing). This work should be completed individually. Identify one disorder and explain the pathophysiology of the disorder and the manner in which the disorder impacts swallowing. Describe the differential effects of the disorder on each phases of the swallow. Topics should be approved by January 21 st. At least three references should be cited. This work may be completed in pairs. Identify one evaluation or treatment technique for dysphagia in children or adults. Describe in detail how and why you would implement the technique. Specify when the technique would and would not be indicated. Refer to efficacy data that supports its use. At least three references should be cited. Topic should be approved by February 25 th. This work may be completed in pairs. Electronic health records (HER): Each student will subscribe to Neehr Perfect and will complete a scavenger task using the EHR. FEES or VFSS observation: Each student will observe one FEES or VFSS and complete a written report on the observation. Midterm exam: This exam will assess understanding of course content, classroom discussions, and assigned readings during the first eight weeks of the semester. Final exam: This comprehensive in-class exam will assess understanding of course content, classroom discussions, and assigned readings. Grading Assignment % Final grade Due date Papers 10 January 28; February 4; April 22 Midterm exam 15 February 25 NEEHR Perfect Scavenger Hunt 5 March 25 FEES/ VFSS observation 5 April 15 (latest) Final exam 45 April 29 Work must be turned in in-person during class on the due date Written work will not be accepted if submitted past the due date Work submitted with spelling, punctuation, or syntactic errors, and work that lacks structure and cohesion, will receive one grade lower than the achieved grade. No extra credit assignments will be given. Grading Scale Letter grade Percentage points A 93-100 % A- 90-92 % B+ 87-89 %
B 83-86 % B- 80-82 % C+ 77-79 % C 73-76 % Course Policies Attendance policy: Students are expected to attend and participate in all scheduled class meetings. Should a class be missed, the student will be responsible for the material presented during that class. Academic Integrity policy: Academic integrity: Evidence of cheating or plagiarism will result in a zero grade for the submitted work. Please see the SHU Academic Standards Policies and Procedures (http://www.sacredheart.edu/media/sacredheart/ academics/4181_graduate_ policies_and_procedures.pdf) for a full descriptions of academic integrity and examples of violations. ADA policy Students with disabilities should contact the Jadersevits Learning Center (http://www.sacredheart.edu/officesservices/jandrisevitslearningcenter/) Additional expectations: Cell phones should be turned off during class time. Students are expected to participate in group discussions and contribute equally to group assignments. Class Schedule Date Topics Readings 1/14 Introduction: Incidence & prevalence Signs & symptoms Consequences of dysphagia Phases of the swallow Biomechanics Bolus preparation, propulsion Neural control Central, peripheral Respiration Airway protection, respiratoryswallow coordination 1. Corbin-Lewis & Liss, Chapter 1 (Oral structural framework and muscles); Chapter 2 (Phayngeal structural framework, muscles); Chapter 3 (Esophageal framework); Corbin-Lewis & Liss, Chapter 4 (Neurology) Corbin-Lewis & Liss Appendix A (Cranial nerves); pp.138-40 (Anatomical planes) 2. Altman, KW., Yu, GP & Schaefer, SD. (2010). Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Archives of Otolaryngology Head and Neck Surgery. 136, 784-9. 3. Ekberg, O., Hamdy, S., Woisard, V., Wuttge- Hannig, A. & Ortega, P. (2002). Social and psychological burden of dysphagia: its impact on 1/21 Normal aging Swallow disorders Neurologic etiologies CVA/ TBI/ neoplasm Infection/ toxins diagnosis and treatment. Dysphagia, 17, 139-146 1. Corbin-Lewis & Liss. Chapter 6 2. Ney, D., Weiss, J., Kind, A. & Robbins, J. (2009). Senescent swallowing: impact, strategies and intervention. Nutrition in clinical practice, 24, 395-413
Degenerative diseases Vascular disease Systemic HIV/AIDS 1/28 Swallow disorders (cont d) Structural etiologies Head and neck cancer Cleft palate Zenker s diverticulum Iatrogenic etiologies Medical and surgical interventions Tracheotomy 2/4 Clinical assessment refresher Screening History Dx, PMH, psychosocial history, nutritional status Bedside evaluation Cognitive status Respiratory status Sensorimotor exam Food trials Blue dye test Impressions Recommendations Instrumental assessment: Imaging: Videofluorography FEES Ultrasonography Non-imaging: Electromyography Manometry Scintigraphy 2/11 Treatment of swallowing disorders in adults: Treatment candidacy Treatment techniques Oral motor exercises Sensory augmentation Swallowing maneuvers Compensatory strategies Postural changes Thermotactile/ gustatory stimulation Adaptive equipment Education Discharge planning 2/18 Treatment of swallowing 3. Readings to be provided by students. 1. Corbin-Lewis & Liss Chapter 7 2. Readings to be provided by students. 1. Corbin-Lewis & Liss, Chapter 5 2. MASA: The Mann Assessment of Swallowing 3. Leder et al. (2013). Can an oral mechanism examination contribute to the assessment of odds of aspiration? Dysphagia, 28, 370-4. 1. Corbin-Lewis & Liss, Chapter 4 2. Logemann, Chapters 3, 4, 5 3. Martin-Harris et al. (2008). MBS Measurement Tool for Swallow Impairment MBSImp: Establishing a Standard. Dysphagia, 23, 4, 392-405. 4. Rosenbek et al. (1996). A Penetration- Aspiration Scale. Dysphagia, 11, 93-98. 1. Robbins, J et al., (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. JSLHR, 1, S276-300 2. Readings to be provided by students
disorders in adults (cont d) 2/25 Midterm No readings 3/4 Spring break 3/11 Nursing simulation lab No readings 3/18 FEES demonstration Clinical decision making continued: Cultural/ ethical considerations Rights Patients Family/ care-giver Nutrition and Hydration Non-oral feeding Frazier Free Water Protocol 3/25 Normal development of feeding and swallowing Prenatal Neonatal Infants and toddlers 4/1 No Class 4/8 Assessment of pediatric dysphagia 4/15 Treatment of pediatric dysphagia 4/22 Dysphagia management in a classroom setting 4/29 FINAL Course Policies Guest lecturer: Cheryl Rowe, CCC-SLP 1. McMahon, M.M., Hurley, D.L., Kamath, P.S. & Mueller, P.S. (2005). Medical and ethic aspects of long-term enteral tube feeding. Mayo Clinic Proceedings, 80, 1461-76 3. Hinson et al., (2014). Dysphagia in Hospice: the roles of social workers and speech language pathologists. Perspectives, 173-186 Morris & Klein, Chapters 4, 5, 6 Guest lecture: Taryn Rogers, CCC-SLP Readings to be announced. Morris & Klein, Chapters Mabry-Price (2014). Dysphagia services in the school setting, Perspectives, 152-6 LSHSS (2008) - all articles in Volume 39 Academic Honesty: A standard of honesty, fairly applied to all students, is essential to a learning environment. Students abridging a standard of honesty must accept the consequences; penalties are assessed by appropriate classroom instructors or other designated people. Serious cases may result in discipline at the college or University level and may result in suspension or dismissal. Dismissal from a college for academic dishonesty, constitutes dismissal from the University.(University Student Handbook) Attendance and Class Participation: Students are expected to attend each classattendance will be taken. Each student is expected to read assigned material prior to class and participate in class discussions. Students may be called on to answer questions and provide opinions during discussions. Students who miss class are responsible for content. Any student who misses a class has the responsibility for obtaining copies of notes, handouts, assignments, etc. If additional assistance is still necessary, an appointment should be scheduled with the instructor. Class time is not to be used to go over material with students who have missed class. Submission of work taken directly from another source (e.g. lesson plan copied from a book, the internet, or material developed by another student) will be considered plagiarism and grounds for no credit on the assignment. Students are encouraged, however, to use a variety of resources in obtaining ideas and
illustrations that will help them complete assignments independently. See the APA Guide for the correct method to cite other authors' work. University policy dictates that students must seek the instructor's permission to record class lectures. All cell phones/pagers must be turned off during class time. Students are required to show conduct consistent with professional standards as discussed in class when conducting on-site observations. Work done outside of class must be reasonably correct in mechanics (e.g. spelling, grammar, punctuation, etc.). Points will be deducted for inadequate work. All typed assignments completed outside of class must be double-spaced, using Times, Times New Roman, or Arial font. All font sizes for typed assignments must be size 11-12. Any font size less than 11 or larger than 12 will be returned for re-typing to required font size. APA style is required for written papers, including table, figure, and graph formats, references and citations, and appropriate professional language use. In ALL work, use person-first language to be consistent with IDEA. Emphasize the person more than the disability (i.e., a child with Down syndrome, NOT a Down syndrome child). Student work will be returned as promptly as possible. All assigned work is due at the beginning of class on the due date designated in the course syllabus. Work submitted late will receive an automatic 5-point reduction from the earned grade. Students are encouraged to submit all assignments on time. Competency: In this course, your knowledge will be assessed on the appropriate portions of the exams, or other assignments. The American Speech-Language Hearing Association has set a competency of 80% or better on these assessments to meet certification standards. Students failing to attain the set criteria on a required competency assessment will be provided a remediation plan and an additional attempt to pass the competency. If students do not pass the competency a second time, one additional remediation will be provided. For students failing to attain the set criteria on a required competency assessment after the third attempt, the department and university are not able to recommend their application for ASHA certification and state licensure, even though they may receive an acceptable course/clinic grade or exceed the minimum GPA. ADA Policy Students with disabilities needing academic accommodation should register with and provide documentation to Jandersevits Learning Center; no accommodations can be provided without written recommendations from JLC.