Advanced Topics in Dysphagia

COMD 7V91 004

Spring 2005

Tuesdays: 2:30 p.m. to 4:15, Room A229

Instructor: Helen Kenedi (214 905 3112, kenedi@utdallas.edu)
Pre-requisite: Introduction to Dysphagia

Dysphagia is an area of Speech Language Pathology where we must be concerned with

the medical safety of our patients. The purpose of this course is to build on knowledge
and skills gained in the Introduction to Dysphagia Class by focusing on advanced
topics/skills required of Speech-Language Pathologists to successfully practice
dysphagia in today’s demanding health-care environment.

We will begin with a review of the anatomy and physiology of the normal and abnormal
swallow followed by facilitation & compensation techniques & diets. We will then
discuss signs and symptoms of dysphagia as they relate to specific medical diagnoses and
then discuss the modified barium swallow, with time spent on reviewing, interpreting and
report writing. Additionally, guest speakers will present lectures regarding pediatric
dysphagia. The information presented in this class will also include associated topics
such as esophageal dysphagia and ethical issues and decision-making with respect to
dysphagia.

Acquired skills will be demonstrated by the completion of two exams over information
covered in readings, lectures, class discussion and a project. A passing grade must be
obtained in each of the two sections (exams) and the project in order to have passed the
class.

Objectives:
Students will be able to:
1. Identify normal and abnormal swallowing function as it relates to swallowing.
(Std. III-B, III-C, III-D)
2. Assess and diagnose swallowing disorders in each of the four stages of
swallowing based on case studies and viewing tapes of modified barium swallow
studies. (Std. III-C, III-D, IV-G)
3. State signs and symptoms of dysphagia associated with a variety of adult and
pediatric medical diagnoses. (Std. III-C, III-D, IV-G)
4. Use assessment data to develop treatment plans for individuals who are diagnosed
with dysphagia. (Std. III-C, III-D, IV-G)
5. Understand relationship between dysphagia and related diagnoses (Std. III-C,
III-D, IV-G)
6. Be aware of ethical considerations and professional issues that related to the
assessment and treatment of dysphagia. (Std IV-G)
Required Texts:
Adult:
Logemann, J. (1998) Evaluation and treatment of Swallowing Disorders (Book used in
Intro to Dysphagia)
Swigert, N. (2000) The Source for Dysphagia Updated and Expanded
Corbin-Lewis, Liss & Sciortino (2004) Clinical Anatomy & Physiology of the Swallow
Mechanism

Pediatric: (Book used in Intro to Dysphagia)

Morris, S. E. & Klein, M.D. (1987) Pre-Feeding Skills: A Comprehensive Resource
For Meal TimeDevelopment, 2nd Edition

Semester Schedule:

Lecture 1: Jan 11
Medical History & Bedside Swallow Exam: Review
Review of Anatomy & Physiology
Swigert: Chapters 1 & 3

Lecture 2: Jan 18
Facilitation, Compensation & Diet
Corbin-Lewis, Liss & Sciortino: Chapter 6
Swigert: Chapter 7, Logemann: Chapter 6 (Review from Intro)

Lecture 3: Jan 25
Neurologic Lesions & Degenerative Diseases
Corbin-Lewis, Liss & Sciortino: Chapter 6
Logemann: pages 303 – 306 and Chapters 9 & 10

Lecture 4: Feb 1
Trachs & Vents/Medically Complex Patients
Swigert: Chapter 9
Corbin-Lewis, Liss & Sciortino: Chapter 7 – p. 187 - 203
Lecture by Jenny Reynolds, MS CCC & Laura Hayden, MS CCC

Lecture 5: Feb 8
Esophageal Disorders
Corbin-Lewis, Liss & Sciortino: Chapter 3 & pages 203 - 209

Lecture 6: Feb 15
Documentation: Goals and Progress Notes
MBS: Candidacy and Interpretion: Therapy & Medical Alternatives
Logemann: Chapter 11, and Chapters 4 & 5 (Review from Intro)
Swigert: Chapter 6: Sample Cases & Chapter 7
Lecture 7: Feb 22
Test on Lectures 1 – 5 (30%)

Lecture 8: Mar 1
Continuation of MBS & Report Writing
Corbin-Lewis, Liss & Sciortino: Chapter 5

March Break

Lecture 9: March 15
Dysphagia & Nutrition
Saliva Management, Dental Hygiene, Water & Aspiration
Russell Mills: Chapter 7

Lecture 10: March 22

Swallowing Programs in the NICU
Morris & Klein: Chapters 8 & 21
Lecture by Jenny Reynolds MS CCC & Laura Hayden M.S. CCC from Baylor University
Medical Center

Lecture 11: March 29

Swallowing & Feeding in Children’s Rehab
Morris & Klein: Chapter 17
Lecture by Patty Wren, MS CCC from Our Children’s House at Baylor

Lecture 13: April 5

Fiberoptic Endoscopic Evaluation of Swallowing
Lecture & Demonstration by Amy Maddox at
Baylor Institute for Rehabilitation
(Reading from Lecture 8)

Lecture 14: April 12

Head and Neck Cancers
Logemann: Chapters 7 & 8
Corbin-Lewis, Liss & Sciortino: Chapter 7 – pages 210 - 227
Lecturer TBD

Lecture 15: April 19

Group Presentations/Individual Project (TBD – 20%)
Ethical Considerations & Decision-Making
Nancy B. Swigert: The Source for Dysphagia, Chapter 5

Lecture 16: April 26

FINAL EXAM (50%)
This course has been designed to ensure that students demonstrate required knowledge
and ability as outlined in the Standards and Implementations for the Certificate of
Clinical Competence in Speech-Language Pathology. The specific standards addressed
in this course are:

Standard III-A
The applicant must possess skill in oral and written communication sufficient for entry
into professional practice.
Demonstrated via class discussion, class project and exams.

Standard III-D
The applicant must demonstrate knowledge of the nature of speech, language, hearing,
and communication disorders and differences and swallowing disorders, including the
etiologies, characteristics, anatomical/physiological, acoustic, psychological,
developmental, and linguistic and cultural correlates. Specific knowledge will be
demonstrated in this class in the area of dysphagia.
Provided via class lectures including guest speakers, readings, videotape viewings and
demonstrated via class discussion, class project and exams.

Standard III-E
The applicant must possess knowledge of the principles and methods of prevention and
assessment, and intervention for people with communication and swallowing disorders,
including consideration of anatomical/physiological, psychological, developmental, and
linguistic and cultural correlates of the disorders.
Provided via class lectures including guest speakers, readings, videotape viewings and
demonstrated via class discussion, class project and exams.

Standard III-F
The applicant must demonstrate knowledge of standards of ethical conduct.
Provided via class lecture and readings and demonstrated via class discussion.

Standard III-G
The applicant must demonstrate knowledge of processes used in research and the
integration of research principles into evidence-based clinical practice.
Provided via class lectures, readings and project.

Standard III-H
The applicant must demonstrate knowledge of contemporary professional issues.
Provided via lectures including guest speakers, readings and demonstrated via class
discussion and exams.

Standard III-I
The applicant must demonstrate knowledge about certification, specialty recognition,
licensure, and other relevant professional credentials.
Provided via lectures and readings and demonstrated via class discussion.
Students will:

1. Demonstrate knowledge of the normal/abnormal anatomy and physiology of

swallowing in a developmental framework across the age continuum.
2. Demonstrate knowledge of the pathophysiology (eg. disorders in stages of the
swallow) of swallowing and feeding disorders in a developmental framework
across the age continuum
3. Describe/identify signs and symptoms of swallowing and feeding disorders in a
developmental framework across the age continuum.
4. Describe/demonstrate knowledge impact of cognitive, behavioral and medical
status on swallowing and feeding disorders.
5. Develop a treatment plan stating compensatory, facilitation and diet interventions
for the management of pediatric and adult clients with dysphagia
6. Identify and describe signs and symptoms of dysphagia associated with a variety
of medical diagnoses, e.g. stroke, TBI, premature babies, syndromes.
7. Interpret, integrate and synthesize information to develop a diagnosis and make
appropriate recommendations for intervention/a treatment plan.
8. Develop setting appropriate interventions plans taking into consideration all
aspects of the patient’s dysphagia, including prognosis, related medical diagnoses
and ethical considerations.
9. Discuss and develop measurable and achievable goals to meet a client’s needs and
target functional outcomes.
10. Demonstrate ability to follow correct protocol during a bedside swallow exam.
11. Demonstrate knowledge of dysphagia terminology and information to be included
for documentation/report writing of bedside swallow exam and modified barium
exams.
12. Identify roles and responsibilities of other professionals on the dysphagia team
and how the Speech-Language Pathologist plays a key role in this interaction.
13. Identify standards of ethical conduct as they relate to the practice of dysphagia.
14. Discuss cultural issues that relate to the practice of dysphagia.

As measured by:
Successful completion of exams
Successful completion of class exercises
Participation in class discussion
Project/Class Presentation of Research in Area of Interest