Dysphagia Research Bites

When a patient can’t swallow their tablets, the conversation often ends with “take it with yoghurt” or “check with the pharmacist if it can be crushed.” But what happens to the medication, and the person, after that?  Clinical Pharmacist Mike Hewson joins Chantelle on Dysphagia Research Bites to unpack the medication misadventures that can follow when tablets are cut, crushed or hidden in food, and why speech pathologists and pharmacists keep handballing a problem that belongs to both professions.  In this episode we cover: What a “medication misadventure” actually is and why older adults on multiple medications are most at riskWhy “is it coated?” is not enough to decide whether a tablet can be crushedWhat can be lost when medications are cut, crushed or opened, and which drugs leave very little margin for errorThe problem with mixing medications into food and thickened fluids, and why keeping food and medicine separate matters for enjoyment and dignityHow home medicines reviews work and why a pharmacist in your client’s life can be your best allyA screening tool for pill swallowing difficultyMedications that cause drowsiness or dry mouth and may be making swallowing harderWhy pill swallowing has been called an “orphan task”, and what real interdisciplinary collaboration could look like The publication this episode is based on:Lau, E. T. L., Steadman, K. J., Cichero, J. A. Y., & Nissen, L. M. (2018). Dosage form modification and oral drug delivery in older people. Advanced Drug Delivery Reviews, 135, 75–84. https://doi.org/10.1016/j.addr.2018.04.012 Other resources mentioned in this episode:PILL-5 Questionnaire: -       Pdf copy: https://tiglutik.com/wp-content/uploads/2020/07/PILL-5-Screening-Questionaire.pdf-       Online version: https://gloup.com.au/pill-5-assessment TGA Approved Medication lubricants:-       https://gloup.com.au-       https://tabletease.com.au For more clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Is it a case of trouble with swallowing or trouble with eating? In this episode, Dr Megan Parsons, medical speech-language pathologist, unpacks a framework that changed how she thinks about swallowing problems. Chantelle and Megan explore why “dysphagia” isn’t always a problem of the swallow itself, and why working out what is driving the difficulty might be the most important clinical question we ask.If you’ve ever documented “dysphagia” without being sure what was driving it, this episode is for you. In this episode we cover:What cognitive dysphagia is, and what it looks like at mealtimesWhy a patient can have intact swallowing anatomy and physiology and still not eatWhether “cognitive dysphagia” belongs across populations, including adults with developmental and intellectual disabilityA systems-based framework for dysphagia and how it shifts assessment, chart review and documentationWhen the swallow isn’t the problem, and how to flag concerns outside our scope without handballing the patientHow to look for respiratory contributors to dysphagia during a clinical swallow evaluationHow to see natural eating behaviour in a hospital setting, and why involving family mattersThe role of clinical reasoning in what makes us pathologists, not just therapists The publication this episode is based on:Winchester, J & Winchester, C (2015). Cognitive dysphagia and effectively managing the five systems. Perspectives on Gerontology, 20(3), 116–132.You can access the article here: http://dysphagiamanagement.com/wp-content/uploads/2015/03/CognitiveDysphagia_Winchester_2015.pdf For more clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Safety, nutrition, enjoyment and the dining experience all need to be part of the conversation when we are talking about texture modified meals in aged care. In this episode of Dysphagia Research Bites, Chantelle sits down with Vanessa Chan to unpack a mixed methods study looking into these very things. They explore the whole journey of a meal, from the kitchen to the dining room, and what speech pathologists can do to influence it. In this episode we cover:Why the whole mealtime workflow matters, from preparation and labelling through to serving and feeding assistanceWhether texture modified diets are being over-prescribed, and what happens when recommendations are changed without an SLP reviewWhy an instrumental assessment isn't always feasible in the community and aged care, and what that means for practiceThe problem with texture modified menus: limited variety, inconsistent quality and nutritional gapsHow access to drinks, thickening practices and staff training can affect residents' hydration and safetyWhy some residents choose to avoid the dining room, and how our own assumptions as clinicians can get in the wayHow well IDDSI has been implemented in practice, and what needs to improveWhy choking risk deserves more attention in our profession The publication this episode is based on:Wu, X., Yousif, L., Miles, A., & Braakhuis, A. (2022). Exploring meal provision and mealtime challenges for aged care residents consuming texture-modified diets: A mixed methods study. Geriatrics, 7(3), 67. https://doi.org/10.3390/geriatrics7030067. PMID: 35735772. Additional resources for aged care providers can be found at Swallowing and Dysphagia Support: https://www.swallowinganddysphagiasupport.com.au For more community-based clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

How many times does your patient swallow in a minute? It sounds like a simple question but the answer might tell you more than you'd expect. In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Sonal Pathak to explore spontaneous swallowing frequency: what it is, how it's measured, and why it could become one of the most practical objective tools in your clinical toolkit, both at the bedside in hospital and out in the community. In this episode we cover: The difference between spontaneous and volitional swallows, and why this distinction matters for how you measure themWhy the measurement environment needs to be carefully controlled — and what can accidentally inflate your dataHow long you actually need to record (the answer may surprise you)The role of spontaneous swallowing frequency as a screening tool in acute care, and what makes it accessible to non-SLP staffWhy Sonal's doctoral research focused on this measure as an outcome measure in a post-acute setting and what that means for how we evaluate treatment effectivenessWhy this measure may be particularly useful for clients with mild or subclinical dysphagia where other clinical signs are absent  One of the publications this episode is based on:Crary, Carnaby & Sia (2013): https://pubmed.ncbi.nlm.nih.gov/25088166/ For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

What if you could interpret a video fluoroscopy report the way a doctor reads a blood test, with clear reference ranges, and the ability to say with confidence whether a value is within or outside what's expected for a healthy adult? That's exactly what Dr Catriona Steele and her team at the University of Toronto have been working on, and in this episode she walks us through what they've found. In this episode we cover:What prompted the development of VFSS reference values.How the ASPEKT method differs from ordinal rating tools like MBSImP and what it means to measure swallowing rather than describe itWhat the reference data tells us about residue, and why ASPEKT's approach to measuring residue is conceptually different from the Bolus Clearance Ratio and DIGESTThe 2D vs 3D measurement problem: the validity challenges of pixel-based area measures and what Catriona's team is doing about itHow many thin fluid swallows you actually need before you can confidently rule out aspiration and whether consecutive sips countWhy bolus position at swallow onset was dropped from the reference value framework  and what replaced itWhat emerging ASPEKT data is showing across clinical populations including Parkinson's disease and COPDASPEKT Academy and the clinical workshop coming to Australia The publications this episode is based on:Steele, C. M., Peladeau-Pigeon, M., Barbon, C. A. E., Guida, B. T., Tapson, M. S., Valenzano, T. J., & Waito, A. A. (2023). Reference values for videofluoroscopic measures of swallowing: An update. Journal of Speech, Language, and Hearing Research, 66(8), 2758–2773. https://doi.org/10.1044/2023_JSLHR-22-00608Updated 2026 Reference Values available here: https://figshare.com/s/428ddbd2d1d009abcd01Register for upcoming ASPEKT VFSS Workshops Here:https://steeleswallowinglab.ca/srrl/education/aspekt-academy/#:~:text=ASPEKT%20Academy%20is%20a%202%2Dday,be%20offered%204%20times.%20The For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

Aspiration and aspiration pneumonia are not the same thing. We know this theoretically. In this episode of Dysphagia Research Bites, Chantelle sits down with Melissa Kane to unpack a 2022 tutorial paper that illustrates the case for looking beyond aspiration itself and toward the individual: their host defences, their medical complexity, their oral health, their lifestyle, when determining the real risk of an adverse event.This episode covers:Why the presence of aspiration does not have a linear relationship with adverse outcomesThe BOLUS Framework: a clinical tool that consolidates existing evidence into a practical set of risk-assessment questions spanning Bolus variables, Oral care, Lifestyle and ADLs, Unintended (Iatrogenic) risks, and System HealthHow oral health, feeding dependence, mobility, tube presence, and medical co-morbidities each factor into aspiration riskThe importance of person-centred language when discussing risk with clients and familiesHow using this framework in a real-world case enabled a client who was nil by mouth to significantly increase their oral intake and improve quality of lifeThe publication this episode is based on:Palmer, P. M., & Padilla, A. H. (2022). Risk of an adverse event in individuals who aspirate: A review of current literature on host defenses and individual differences. American Journal of Speech-Language Pathology, 31(1), 148–162. https://doi.org/10.1044/2021_AJSLP-20-00375Some of the tools & articles mentioned in this episode:EAT-10 (Eating Assessment Tool-10):https://www.nhsexpertcorner.com/sites/default/files/2021-04/eat10toolenglish_form.pdfDrooling Frequency and Severity Scale (DFSS): https://www.movementdisorders.org/MDS-Files1/PDFs/Task-Force-Papers/sm004.docFunctional Oral Intake Scale (FOIS): https://www.archives-pmr.org/article/S0003-9993(05)00196-6/abstractOral Health Assessment Tool (OHAT):https://www.dental.sa.gov.au/assets/downloads/Care-for-older-people-toolkit/Residential-care/3.-Oral_Health_Assessment_Tool-OHAT.PDFLangmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 13(2), 69–81. https://doi.org/10.1007/PL00009559 — available via: https://pubmed.ncbi.nlm.nih.gov/9513300/Ashford, J. R. (2005). Pneumonia: Factors beyond aspiration. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 10–16. https://doi.org/10.1044/sasd14.1.10 — the Three Pillars framework is also summarised at: https://www.sasspllc.com/three-pillars-of-pneumoniaO'Keeffe, S., Murray, A., Leslie, P., Collins, L., Lazenby-Paterson, T., McCurtin, A., Mulkerrin, S., & Smith, A. (2021). Aspiration, risk and risk feeding: A critique of the Royal College of Physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing, 24(1), 1–10. https://doi.org/10.3233/ACS-210031For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

Yvonne talks about the parts of dysphagia care that rarely make it into our clinical training, as a qualified chef, winemaker, and head and neck cancer survivor living with chronic dysphagia. In this episode she shares her experience of going from eating her way through back alleys in Vietnam to not being able to swallow thickened water. I can honestly say that I learnt so much from Yvonne and realised that I need to do better to support clients living at home with dysphagia. In this episode we cover:Why Yvonne says the real fight began after treatment ended not during surgery or chemoradiotherapyThe concept of commensality and why the deeply human need to eat socially is one of the most overlooked dimensions of chronic dysphagiaWhat Yvonne was actually told at discharge, and the gap between that and what she needed to knowHow caregiver involvement in meal preparation, however well-intentioned, can gradually sever a person's connection to foodWhy "just eat soft food" is not a plan, and what asking "what is your favourite food?" could change about the way we approach managementWhat the mealtime environment at home actually looks like and why it matters more than we thinkThe psychosocial and emotional dimensions of chronic dysphagia that our clinical frameworks tend to leave behind Resources mentioned in this episode:Yvonne's book GULP: yvonnemcclaren.comThe No Feeding Tubes Podcast The Commensality Comeback Movement and the Back at the Table Framework — details via Yvonne's website For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

What if one of the most overlooked aspects of dysphagia management isn't about swallowing at all — it's about chewing? In this episode of Dysphagia Research Bites, Chantelle sits down with Carol, an oral health therapist who works with adults with disability and complex needs, to unpack the Functional Chewing Training (FuCT) protocol.Yes, the article they discuss was written for children with cerebral palsy. But don't let that put you off. As Chantelle and Carol discuss in this episode, the principles can translate meaningfully to adults — particularly those with intellectual disability, developmental disability, or acquired neurological conditions. There is little chewing rehabilitation literature for adults, and this article is one of the most structured, clinically applicable frameworks available.Yes we know... the acronym is an interesting choice.In this episode we cover:The four components of the FuCT protocol: postural alignment, food positioning on the molars, sensory stimulation, and food consistency gradingWhy assessing posture and trunk control is the non-negotiable first step before any chewing interventionThe role of the chew tube and tools like the Gnosh Sidebiter in stimulating the chewing muscles and encouraging lateralisationHow tongue thrusting relates to chewing dysfunction, and why addressing the thrust may need to come before oral hygiene can even happenThe link between chewing, saliva, sensory input, and nutrient absorption (including the GLP-1 connection you probably didn't learn in university)How reduced mastication may be associated with cognitive decline — and what the research suggests about blood flow and the hippocampusWhy a dietitian referral should be on your radar for clients with significant chewing dysfunction, even in the absence of obvious weight lossThe publication this episode is based on:Serel Arslan S, Demir N, Kılınç HE, Karaduman AA. Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double-blind randomised controlled trial. J Oral Rehabil. 2017;44(1):46–52. doi: 10.1111/joor.12459You can find more information on the Gnosh Sidebiter here: https://www.sidebiter.comFor comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

Let's unpack the evidence on cough reflex testing: what it tells us, what it doesn't, and whether clinicians are making a dangerous assumption when Cough Reflex Testing (CRT) results aren't available. In this episode we cover: What cough reflex testing is and how it works as a screening tool for silent aspiration riskThe key finding from Phoebe's research: a failed CRT leads to significantly more restrictive management, but in the absence of any CRT result, clinicians manage patients almost identically to those who passedWhat that pattern reveals about our default assumptions around airway sensationHow aspiration pneumonia risk factors influenced clinician decision-making in the studyThe sensitivity and specificity of CRT and why it's not a perfect predictor of aspirationThe complexity of interpreting CRT results across different textures — including patients who silently aspirate on thickened fluids after overtly aspirating on thinWhy Phoebe frames CRT as one piece of a bigger clinical picture, not a standalone decision-making toolWhat Phoebe would want her own caregivers to know if she ever developed dysphagia The publication this episode is based on:Darrock, K., Wallace, E., Guiu Hernandez, E., Huckabee, M.-L., Mills, M., & Macrae, P. (2024). The influence of cough reflex testing on patient management. Journal of Speech, Language, and Hearing Research, 67, 2987–2996. https://doi.org/10.1044/2024_JSLHR-24-00174 Other articles mentioned: Miles A, Zeng IS, McLauchlan H, Huckabee ML. Cough reflex testing in Dysphagia following stroke: a randomized controlled trial. J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23. PMID: 23671548; PMCID: PMC3651073. https://pubmed.ncbi.nlm.nih.gov/23671548/ Miles A, Moore S, McFarlane M, Lee F, Allen J, Huckabee ML. Comparison of cough reflex test against instrumental assessment of aspiration. Physiol Behav. 2013 Jun 13;118:25-31. doi: 10.1016/j.physbeh.2013.05.004. Epub 2013 May 12. PMID: 23672854. https://pubmed.ncbi.nlm.nih.gov/23672854/ For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

If you've ever felt like your dysphagia training just doesn't quite fit when you're sitting at someone's kitchen table, you're not wrong, and this episode is going to explain exactly why. In this solo episode of Dysphagia Research Bites, Chantelle shares the framework at the heart of her clinical practice and the reason she started this podcast and her business: Dysphagia management in the community requires a different approach.Chantelle breaks down the acute care principles that most of us were trained on, and makes the case for why applying them in a community setting isn't just a poor fit, it's leaving community SLPs underprepared and their clients underserved. If you've ever wondered whether you're doing something wrong in your community caseload, this episode might just reframe everything.In this episode we cover:Why the acute care model of dysphagia management doesn't translate to community practice — and what to use insteadThe specific populations and practice contexts where this gap is most pronouncedWhat the research says about how experienced community SLPs actually approach dysphagia managementWhy quality of life, carer involvement, and shared decision-making have to sit at the centre of community dysphagia carePublications mentioned in this episode:Howells, S. R., Cornwell, P. L., Ward, E. C., & Kuipers, P. (2019). Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. International Journal of Language & Communication Disorders, 54(6), 971–981. https://doi.org/10.1111/1460-6984.12499Moloney J, Walshe M. Managing and supporting quality-of-life issues in dysphagia: A survey of clinical practice patterns and perspectives in the UK, Ireland and South Africa. Int J Lang Commun Disord. 2019 Jan;54(1):41-49. doi: 10.1111/1460-6984.12429. Epub 2018 Oct 26. PMID: 30362200.If you are after a comprehensive self-paced course that teaches you how to conduct a clinical swallow evaluation in a community or post-acute care setting then check out this comprehensive course: https://www.dysphagiabites.com/clinical-swallow-evaluation-course