161: Complex dysphagia in Outpatient Rehab with Carolyn Abraham, M.S., CCC-SLP, BCS-S, CLT

Hilary and Steve join Leigh Ann on the podcast to discuss the development of the MedConcerns app to help healthcare providers and families overcome the challenges of understanding and meeting the medical needs and concerns of people with aphasia. The app creators share about the healthcare inequality that exists for people with aphasia due to lack of widespread use of effective communication supports, and a lack of training for healthcare providers on meeting unique communication needs. They discuss how this app was designed to increase access to healthcare for people with aphasia, while also reducing the communication challenge for healthcare providers. People with aphasia have a right to equal access to healthcare, and can communicate with the right supports. The MedConcerns app embeds communication supports, making patient-provider communication easier no matter the level of training. Check out the show notes at https://www.speechuncensored.com/podcastepisodes/165

Eating and drinking brings pleasure to most; however, dementia can bring about significant changes in one’s communication, cognition, sensation, appetite and ability to eat and drink. When dysphagia and dementia co-occur, speech-language pathologists play a vital role on the interdisciplinary team and should be a cornerstone in care until end of life in this population. This episode focuses the discussion on mealtime modifications to enhance nutrition, hydration and quality of life for these individuals. Treat the individual, not the diagnosis! Dementia looks different for each person, and when eating challenges present, viewing the whole picture is crucial to determine any barriers present that may be impacting their nutrition, hydration and quality of life. Check out show notes at https://www.speechuncensored.com/podcastepisodes/164

Dr Cath Gregory chats about the latest evidence in Functional Neurological Disorders and the speech-language pathologist’s role when working with people with Functional Neurological Communication and Swallowing Disorders. Key Takeaway: (1-2 sentences of the main theme.) Functional neurological disorder (FND) is a problem with the ‘software’ of the brain that can occur across the lifespan. No longer classed as ‘psychogenic’, this disorder is now known to follow a biopsychosocial model of illness. It is essential that a positive diagnosis, rather than a diagnosis of exclusion, occurs. Clear education about the disorder and the use of distraction to help access more autonomic pathways is the current consensus treatment for communication and swallowing disorders. A multidisciplinary approach is always required for people with more complex needs. Check out the show notes on https://www.speechuncensored.com/podcastepisodes/163

Patient-Reported Outcome Measures (PROMs) are a powerful assessment and outcome measurement tool in a person-centered approach - but many SLPs are not yet using this tool. Leigh Ann and Sarah talk about how PROMs have been transformative in their clinical practice - and also how they’ve navigated conversations with colleagues who don’t think PROMs are part of best practice. PROMs provide SLPs a tool to measure all of the ways a person has been positively impacted through speech therapy. There are tons of resources to support use of PROMs, including research articles and Medicare standards. Check out the show notes for Sarah's references and resources located at https://www.speechuncensored.com/podcastepisodes/162

Carolyn and Leigh Ann catch up about outpatient life and then Carolyn deep-dives into a day in the life of a SLP working in an Outpatient Neuro setting, treating complex dysphagia associated with various diagnoses including Head and Neck Cancer, Lung Transplant Recipients.  Carolyn has carved out an exciting specialty in outpatient and demonstrates how there's always opportunities for growth as clinicians through various avenues! Check out Carolyn's fantastic resources in the show notes hosted at https://www.speechuncensored.com/podcastepisodes/161

As SLPs, we need to advocate for our patients even when it’s hard. Irine Chacko joins Leigh Ann on the podcast to describe her experience during COVID-19 that changed her mindset and confidence in advocating and giving a voice to her patients. Irine was selected as the SLP for an acute rehab pilot program initiated at her hospital during COVID-19. Sixteen medically fragile COVID-19 patients between the ages of 40-70 joined the newly established unit from her hospital and neighboring hospitals. All the patients were on the ventilator with tracheostomy and PEG. These were patients in acute care for months and not able to be weaned off and/or did not have the adequate support to do so. By discharge from the pilot program, all patients were off of COVID precautions, alert and oriented, and on a PO diet. This experience taught her to find her voice even when it’s difficult. Check out the show notes for Irine's slide deck and contact info at https://www.speechuncensored.com/podcastepisodes/160

Ainsley Martin joins Leigh Ann on the podcast to discuss grad students and dysphagia preparedness. The majority of graduates from speech pathology graduate programs do not feel they are adequately prepared to manage dysphagia. This is often as a result of lack of clinical experience, limited educational and clinical instruction, and questionable supervision quality. Novel approaches to dysphagia education at the graduate level such as incorporating problem-based learning, providing opportunities for interprofessional education, the implementation of hands-on dysphagia labs, and partnering with clinicians in the community can help to make graduate students more competent and confident in dysphagia management. Check out Ainsley's extensive resource list in the show notes at https://www.speechuncensored.com/podcastepisodes/159

Brooke joins Leigh Ann on the podcast to discuss the role of lymphedema in acute and chronic issues faced by people with head and neck cancer. Topics include causation, prevalence, identification, and the role of the speech pathologist. Lymphedema is a chronic and progressive disease that is highly prevalent in people with head and neck cancer. Lymphedema has the potential to impact swallow function, breathing, communication, and more. Be sure to check out the show notes at https://www.speechuncensored.com/podcastepisodes/158

Hannah and Leigh Ann discuss the bad rap SNFs get. Skilled Nursing Facilities (SNFs) often have a negative stereotype and are considered a less prestigious setting of the Med SLP continuum of care. This artificial hierarchy of Med SLP practice limits our potential to provide high quality care in these settings if we feed into stereotypes. Just like any other Med SLP setting, there are challenges and great opportunities with plenty of room to practice at the top of your scope and provide high quality and evidenced based SLP intervention in a SNF. Hannah shares the story of how she has achieved career goals and advanced her practice skillset while working in SNFs - including starting an in-house FEES protocol and obtaining her BCS-S. Check out the show notes for more information and resources at https://www.speechuncensored.com/podcastepisodes/157

What does it mean to provide care in diverse spaces? Ingrid and Leigh Ann discuss what is possible for achieving outcomes in spaces not researched. Ingrid discusses the ‘how to’ of patient centered care while recognizing the limitations of the internal research. The #1 lesson is understanding that it’s ok to be an expert that continues to learn. Check out the show notes at https://www.speechuncensored.com/podcastepisodes/156