Not all swallowing clinicians have access to instrumental examinations, such as videofluoroscopy or fiberoptic endoscopic evaluation of swallowing, but almost all swallowing clinicians can do clinical examinations. In this episode of Down the Hatch, Ianessa and Alicia weigh in on the merits of leaning too heavily on either clinical examinations or instrumental examinations to diagnose swallowing impairments.

Everybody's Doing It (Down the Hatch)

Swallowing clinicians made it clear that they want more CEUs on normal swallowing at the March 2016 Critical Thinking in Dysphagia Management meeting. In this podcast, Alicia and Ianessa bust a few myths regarding normal characteristics of swallowing and unnecessary dysphagia diagnoses. They also discuss how a clear understanding of normal swallowing can improve dysphagia management. 

What Is Normal?

Physicians play a critical role in dysphagia management, even though swallowing may not have been included in their medical training. This installment of Down the Hatch features a conversation with Dr. Michael Okun, Department Chair of Neurology and Co-Director of the Movement Disorders Center of the University of Florida. We discuss the lack of training across medical disciplines in dysphagia as well as suggestions for how swallowing clinicians and researchers can advocate for improvements in dysphagia management. Get up! Stand up!

Advocacy in dysphagia management: A Neurologist's perspective (Guest: Dr. Michael Okun)

Parkinson's Disease (PD) can lead to swallowing disorders (dysphagia). Swallowing disorders in PD can be serious because it can lead to aspiration pneumonia, which is one of the most common causes of death in PD. In response to a special request by the National Parkinson Foundation (www.parkinson.org), this installment of Down the Hatch (The Swallowing Podcast) focuses on swallowing impairments in PD. Special guest experts Karen Wheeler-Hegland, Ph.D., CCC-SLP and Emily Plowman, Ph.D., CCC-SLP discuss issues related to swallowing disorders in PD for patients, care-givers, speech-language pathologists, physicians, and the general public.

Swallowing Disorders In Parkinson's Disease (DTH 5)

So, what's the deal with e-stim? A question that is often asked. In this episode of Down the Hatch (the podcast about swallowing), doctoral student and SLP Alicia Vose and Assoc. Prof and mentor Ianessa Humbert re-unite after a brief hiatus to take up a controversial topic in dysphagia management - electrical stimulation. I think this topic is in keeping with the climate of 2017 in the United States of America, don't you?

What's the deal with e-stim?

Expiratory muscle strength training (EMST) is a device driven-therapy based in exercise physiology principles and used in dysphagia management. Although it is a non-swallowing treatment, it is known to have important utility in increasing the effectiveness of cough. Hosts Ianessa Humbert and Alicia Vose discuss the ins and outs of EMST with SLP and doctoral student Lauren Tabor.

Expiratory Muscle Strength Training in Dysphagia Management

The Clinical Swallowing Evaluation (CSE) is a critical part of dysphagia management. However, it is often misused and over interpreted. In this high-energy installment of Down the Hatch (The Swallowing Podcast) SLPs Rinki Varindani Desai and Beth Shah, along with Hosts Ianessa Humbert and Alicia Vose, discuss whether the CSE should really be considered a screening and if swallowing is actually being evaluated at all.

Piecing together the Clinical Swallowing Evaluation (CSE)

Down the Hatch (Swallowing Podcast) lucky number 13!
Dr. Catriona Steele, a prolific scientist and swallowing expert, launches the first episode in our series called EXPERT RANT on the following 3 topics: 
1. Revisiting the Clinical Swallowing Evaluation from Down the Hatch 12: Screen versus Evaluation? 
2. Do Penetration-Aspiration Scale scores of 4 and 6 actually exist?
3. Get more aggressive with your rehab!
Solutions: Clinicians and Researchers …. JOIN FORCES!
Enjoy (-:

EXPERT RANT #1 with Dr. Catriona Steele

This installment is focused on the topic of weakness and fatigue. Have you ever decided that one of your dysphagic patients needs strength training? If so, can you define weakness or fatigue? In this episode, we discuss weakness and fatigue with Dr. Leo Ferreira, an associate professor in the department of Applied Physiology & Kinesiology at the University of Florida. He is a clinically trained physical therapist and scientist who studies muscle biology and aims to develop new therapies for skeletal muscle weakness in chronic diseases. Our aim in this podcast is to encourage clinicians who treat dysphagia to re-think whether their patients are truly weak, versus whether they have timing, range of motion, or even sensory abnormalities. Listen, consider, and enjoy!

Wreak Havoc: Are you sure your dysphagic patients need strengthening?

Does more pharyngeal residue mean that there is reduced pharyngeal pressure? Do greater pharyngeal pressures occur when swallowing thicker boluses? Does the Mendelsohn Maneuver reduce UES pressures? Dr. Corinne Jones of the University of Wisconsin (Madison) joins Down the Hatch (The Swallowing Podcast) as our special guest. We discuss Dr. Jones' area of expertise in High Resolution Manometry (HRM) research, including pharyngeal and UES pressures during swallowing.

The Big Squeeze

Diet modifications and swallowing exercises are a mainstay in dysphagia rehabilitation, but do they truly prevent aspiration pneumonia or rehabilitate impaired swallowing? Do researchers have a responsibility to conduct studies that justify or refute frequent SLP use of thickened liquids, swallowing compensatory strategies and/or maneuvers? In this Down the Hatch episode, Dr. Ianessa Humbert and Alicia Vose (doctoral candidate) discuss the clinical decision to not prescribe thickened liquids as well as literature that addresses whether there is evidence to support swallowing exercises to rehabilitate dysphagia.

Diet & Exercise

To address feeding and swallowing impairments in the pediatric population, one requires highly specialized knowledge. Still, pediatric dysphagia is extremely understudied and underfunded and SLP clinicians often learn on the job. In this episode, Dr. Emily Zimmerman, an expert in pediatric dysphagia, primes the Down the Hatch (Swallowing Podcast)listening audience as well as hosts Ianessa Humbert and Alicia Vose on how to approach pediatric dysphagia.

INTO the Mouth of Babes: A Pediatric Dysphagia Primer

The data are abysmal! In a recent publication, partly authored by Down the Hatch Hosts Alicia Vose and Ianessa Humbert, we reveal that SLP identification of swallowing impairments is poor to moderate. Why? Many could not differentiate disordered swallowing events from normal ones. In this installment with Special Guests Justine Allen and Michela Mir (both Doctoral Students and SLPs with clinical experience), we discuss this proverbial Ground Zero. Acceptance: This is the first STEP toward SLP competence in Dysphagia Management.

12 Step Plan for Competence in Dysphagia Management: Acceptance

Do you think we need more swallowing therapies? Do you hand out a standard list of therapy worksheets for many of your patients with swallowing problems? Have you ever thought "Tell me what to do!" when faced with making decisions about treating patients? In this installment of Down the Hatch (The Swallowing Podcast), Alicia and Ianessa discuss the dilemma facing many SLPs who treat dysphagia. Alicia and I suggest focusing on the process of deciding whether therapy is needed and/or which therapy should be recommended, and we suspect that very little time is spent on clinical decision-making (rather just the execution of therapy). This is a skill that SLPs should possess and is required to actually provide the correct individualized treatment, rather than simply providing the same list of swallowing therapies for all of individuals with dysphagia.

Tell Me What To Do!

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com).

The Swallowing Physiology Series: Oral Preparation

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com). See more swallows here, including the squirt swallow, that is discussed in this episode: https://www.youtube.com/channel/UCq8_kb-4JkisYLtrHMQ8bnw/videos

The Swallowing Physiology Series: Base of Tongue Retraction

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Drs. Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com). Also, watch a video here on differentiating swallow delay from pre-mature spillage: https://www.youtube.com/watch?v=DXUHPiRVITc

The Swallowing Physiology Series: Swallow Trigger

Laryngeal vestibule closure (LVC)is one of the most complicated and critical swallowing events, but it remains poorly understood. In this episode of Down the Hatch (The Swallowing Podcast), we continue the Swallowing Physiology Series, with Ianessa and Alicia discussing the ins and outs of LVC and why it is often misunderstood and under-appreciated. By the end of the podcast, hopefully you will understand why listing poor or incomplete epiglottic inversion provides insufficient information about the cause of this type of LVC impairment.

Swallowing Physiology Series: Laryngeal Vestibule Closure

In this last episode of The Swallowing Physiology Series, hosts Alicia Vose and Ianessa Humbert tackle both the pharynx and the upper esophageal sphincter (UES). This includes Down the Hatch Podcast (swallowing podcast)covers structure, function, and relevance to aspiration and residue for the pharynx and UES. We also discuss whether traditional exercises can really impact these structures as well as just plain old swallowing can... begging the questions: 1. Is swallowing the best treatment for swallowing? 2. What role do SLPs play in ensuring that patients get to practice swallowing with a wide range of bolus types?

The Swallowing Physiology Series: Pharynx and UES

What is an expert? Do more years of experience guarantee a deepening of knowledge? Do scientists think differently than clinicians? In this episode of Down the Hatch (The Swallowing Podcast), hosts Alicia Vose and Ianessa Humbert discuss how to obtain knowledge, with an emphasis on swallowing and swallowing disorders. This episode was created in response to feedback from the Swallowing Physiology Series we recently completed, where listeners wanted to know "How do I become an expert in swallowing?" and, importantly, "How do I know who to trust as an 'expert' in swallowing?". Vose and Humbert differentiate Clinical thinking from Scientific thinking and make practical suggestions for how to obtain knowledge, ranging from self-study to academic degrees. How have you deepened your knowledge on the topic of swallowing and swallowing disorders?

Experience versus Expertise Part 1

“I don’t want to be too dramatic, but the NPO is almost like a death sentence … I really think that it should be the last recourse and not the beginning”. This one of many sincere opinions from an individual who has been living with a significant swallowing disorder. In this episode of Down the Hatch, the swallowing podcast, co-hosts Alicia Vose and Ianessa Humbert have a conversation with Jim, who suffered a brainstem stroke, leading to dysphagia. His very candid experience is the heart of why service delivery by Speech Language Pathologists to manage dysphagia does not just potentially impact life, but also LIVELIHOOD. Click to see a clip of this patients swallow: https://youtu.be/OpFjLLDbS-c

GIVE HOPE! Reflections on Living with a Swallowing Disorder

Head and neck cancer can cause devastating swallowing problems, requiring a unique approach. This episode of Down the Hatch (The Swallowing Podcast) includes guest Heather Starmer, M.A., CCC-SLP who has extensive clinical and research expertise in dysphagia due to head and neck cancer. In addition to basics that make this population distinct, we dive into a few soap boxes including whether residue is "a thing"! Despite limited time, you will find this to be a very informative podcast about a very special type of dysphagia. 
Link to her paper on Gabbapentin: https://www.ncbi.nlm.nih.gov/pubmed/24633355

Head and Neck Cancer

“I just listened to your DTH podcast with Jim. In my humble opinion I think this podcast should be required listening for every SLP student and every SLP everywhere who deals with dysphagia….”

“To expose what has become a very comfortable lie in exchange for the integrity and power of the truth is likely the greatest kindness one human can offer to another… As a direct result, I will do better”

“Hi I just listened to Jim share his story. My heart was broken…”

“Honestly, this podcast really spoke to me and motivated me to push…”

These are the sincere responses to the DO BETTER message that has been pushed in the Down the Hatch Swallowing Podcast and that has been emerging among SLPs in swallowing. In this episode, Ed Bice, Alicia and Ianessa Humbert continue discussing the system that influenced Jim’s experience in dysphagia management. It’s a wild, honest, passionate conversation. 
Recommendation: Listen with your adult beverage of choice!

Response to the Give Hope Podcast

The field of Speech Language Pathology is 95% white female. As a result, efforts to increase diversity in this discipline have been ongoing, yet somewhat unsuccessful. It is possible that issues surrounding the whiteness of SLPs could be better explored with open conversations about this matter. Is it a problem? Would more diversity improve patient care or training the next generation? Guests Jessica Forbes, MS, CCC-SLP and Anu Subramanian, Ph.D., CCC-SLP join hosts Alicia Vose and Ianessa Humbert in raucous, candid, controversial, and sometimes explicit, banter about being a white, brown, or other SLP in the field of Speech Language Pathology.

#slpsowhite

There were some issues with the original release of this eposide, so this is a re-release:
Original description: It happens every time. A particular question is posed by one member of an audience of speech language pathologists who treat dysphagia. The question is cautious with a hint of frustration: How do I deal with inadequate modified barium swallow study reports from other speech language pathologists? In this Down the Hatch #9 (Swallowing Podcast), Alicia Vose and I discuss dysphagia documentation dilemmas for the evaluating clinicians who conduct modified barium swallow studies and write reports and for the treating clinicians who rely on the reports from evaluating clinicians to guide the treatment plan for patients in their care. SLP clinician experts Michele Singer and Nicole Roth weigh in to add immediate clinical relevance to this critical, and somewhat controversial, clinical topic.

Re-release: Dysphagia Documentation Dilemma

The Coronavirus (COVID-19) pandemic has drastically changed health care practice around the world. Many medical speech language pathologists are uncertain about how and whether to continue managing patients with swallowing impairments (dysphagia), and if so... whom? In this episode of Down the Hatch, special guests with expertise in swallowing research and clinical practice discuss questions that center around whether SLPs are essential practitioners at this critical time.

Links to sources referenced can be found here:
https://pubmed.ncbi.nlm.nih.gov/25129577/

https://insights.ovid.com/clinical-pulmonary-medicine/cpulm/2018/09/000/aspiration-asp-sh-noun-ambiguous-term-used/4/00045413

https://pubmed.ncbi.nlm.nih.gov/9513300/

https://www.entnet.org/sites/default/files/uploads/covid-19_endosb_lettertoeditor_neurosurgery_update3.23.20.pdf

https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy?fbclid=IwAR2T5mtY9cmBZHzrlC5pksT5yf2SzVyKFNjsOI-ErslyndZzV8qAPsb8XbI


https://annals.org/aim/fullarticle/2763329/covid-19-risk-health-care-workers-case-report

https://sacramento.cbslocal.com/2020/03/05/uc-davis-self-quarantine-test-negative/

  https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers

https://www.ncbi.nlm.nih.gov/pubmed/25807865

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459179/

CMS recommendations: 
https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

AAOHNS's statement as of 3/26:
https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy?fbclid=IwAR1LGbGXaj66oBmwlEwuehHkYIF7odgm4GdhVRnvzBWr3IKWSGq50ngQ8qc

CDC on minimization of transmission within different settings:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html

Ventilation and PPE usage with aerosol transmission:
https://www.google.com/search?client=firefox-b-1-d&q=Factors+involved+in+the+aerosol+transmission+of+infection+and+control+of+ventilation+in+healthcare+premises

High-risk patient factors for severe illness from COVID-19:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html

https://www.cisa.gov/sites/default/files/publications/CISA-Guidance-on-Essential-Critical-Infrastructure-Workers-1-20-508c.pdf?fbclid=IwAR1nrXpoPEIg40jdn4UH-k_TTeZK8-SAP4SyDtWc85xnicLOTjz1tN6O-4E

COVID Era and SLP dysphagia practice

Back by popular demand, Down the Hatch’s Swallowing Physiology Series is now focused on neural control! In our Swallowing NEUROPhysiology Series, hosts Drs. Ianessa Humbert and Alicia Vose focus on concepts related to the central nervous system, not just because it controls swallowing, but also because it is among the most poorly understood and highly requested topics among those who aim to learn more about swallowing. In this installment, we move beyond the peripheral nervous system (cranial nerves) and introduce concepts that include cranial nerve nuclei and central pattern generators within the brainstem that are essential to swallowing.
Full links to papers:
https://www.ncbi.nlm.nih.gov/pubmed/11274347 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992653/

https://link.springer.com/article/10.1007/BF02407121

Swallowing Neural Control: 101

Do you decide which patients will have swallowing therapy or modified diets? Are you aware of your role in modifying Experience Dependent Plasticity as a clinician managing swallowing impairments? In this episode of Down the Hatch (Swallowing Podcast), co-hosts Ianessa Humbert and Alicia Vose continue the Swallowing Neurophysiology Series and discuss Experience Dependent Plasticity in dysphagia management with Dr. Phoebe Macrae. Access the full text manuscript about EDP in Dysphagia Management here (authors Macrae and Humbert 2013): https://link.springer.com/article/10.1007/s40141-013-0025-y

Experience Dependent Plasticity in Dysphagia Management

Sensation is largely overlooked in swallowing science and clinical practice. Why? It's difficult to test and to interpret! In this episode of Down the Hatch (The Swallowing Podcast), special guest Rachel Mulheren, Ph.D., discusses sensation as it relates to swallowing. How are sensation and perception different? How do we use cranial nerve sensory testing to make clinical decisions about swallowing behavior? Can we learn about sensation during videofluoroscopic studies? Although swallowing sensation is poorly understood, we attempt to address these questions and more in this discussion.

Swallowing Sensation and Perception

96.3% of Speech Language Pathologist self-identify as female. In this episode of Down the Hatch Podcast, we are joined by 4 male SLPs to discuss the female dominance of our profession. Our guests Ryan Bransky, Rick McAdoo, Dan Weinstein, and Anthony Avitabile engage in a deep, tangential discussion (trigger warning: strong language at times). But rest assured that our conversation eventually  touches on many points that, at some point, you all may have considered. Does it matter that we are so heavily female dominated? Would patients be served better with more male SLPs? Would we earn more money, more respect with more male colleagues? Listen to our opinions and, please, share yours!

#SLPsofemale

Are there foundational principles that ALL SLPs should know about cranial nerve testing? Are we are checking off a list of nerves we've probed or are we tying behaviors we see back to function? What about relevance to the central nervous system? Dr. Kendrea Garand joins hosts Ianessa Humbert and Alicia Vose in a discussion about how to conduct and interpret cranial nerves among SLPs.

Cranial Nerves

Motor Learning: Swallow Neurophysiology Series

Deglutition talk with Ianessa A. Humbert and Alicia K. Vose

Down the Hatch - The Swallowing Podcast

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