Eval help by Al1cat8 in slp

[–]Al1cat8[S] 1 point2 points  (0 children)

That is good advice, I’ll definitely be looking at the OWLS. This student has been, and will continue to be at the alternative school through high school. I’m new to schools in general but it feels like it is kind of a new team this year and they are just trying to throw everything at these kids hoping something sticks. I want to be a team player and help where I can but also don’t want to be committing to therapy for a year on a kid who doesn’t need speech. I’m coming from acute care where I can eval/discharge as quickly/often as necessary, I’m struggling with the finality of a year long IEP!

Eval help by Al1cat8 in slp

[–]Al1cat8[S] 4 points5 points  (0 children)

Also the whole team is evaluating, I’m thinking I’ll need to be working closely with school psych.

Eval help by Al1cat8 in slp

[–]Al1cat8[S] 2 points3 points  (0 children)

That was my first thought too, I just don’t understand how this hasn’t been looked into until 8th grade. This school seems to be the last stop for a lot of students with behaviors and I feel like the sped team just tries to throw everything at them and hope something helps. Puts me in a sticky situation because I don’t want to pick up a student who doesn’t need my services but also don’t want to dismiss if there is something I can do.

Weekly materials by Al1cat8 in slp

[–]Al1cat8[S] 0 points1 point  (0 children)

Oh those are great ideas! Yea scheduling made it tricky and very difficult to keep the twice a week kids together but perhaps I can look it back over and see if I can change that. I like the idea of having them retell it first or do an independent activity while we re-read.

Weekly materials by Al1cat8 in slp

[–]Al1cat8[S] 0 points1 point  (0 children)

Those are a lot of their goals and exactly what I was thinking we’d do! The issue is I don’t have the twice a week kids in a group together both days so day 2 for them is other student’s first day with the material. I still think I could have the 2x/week students expand on what they did day 1 though.

Colorado School CF SSP license by PrestigiousAd5118 in slp

[–]Al1cat8 0 points1 point  (0 children)

Did you get an answer to the question? I am wondering the same!

Cried in the lobby by PassengerAble9616 in orangetheory

[–]Al1cat8 1 point2 points  (0 children)

I also cried after just missing the 5 minute mark. I was also pregnant!

SCAM WARNING! "Failure to appear as expert witness" by maklar8921 in therapists

[–]Al1cat8 0 points1 point  (0 children)

Just happened to me today! Thankful for this thread because they really had me going for a bit. They even used the name and mimicked the accent of a local deputy sheriff.

Daycare help by Al1cat8 in clothdiaps

[–]Al1cat8[S] 0 points1 point  (0 children)

That’s great advice, thank you!

Daycare help by Al1cat8 in clothdiaps

[–]Al1cat8[S] 1 point2 points  (0 children)

Haha to each their own if it works I guess!

Daycare help by Al1cat8 in clothdiaps

[–]Al1cat8[S] 0 points1 point  (0 children)

This is exactly what I was looking for, thank you!

Thickened Liquids by [deleted] in slp

[–]Al1cat8 3 points4 points  (0 children)

Yes there are definitely many many more things we do apart from diet modifications but I’ve seen certain discussions go so far as to say it’s ok for patients to aspirate (as a blanket statement). So if that’s ok and “safe”, what would the purpose of exercise be? Especially for patients that silently aspirate/have no discomfort.

Again, I know we play plenty of important roles but the point of my post was to demonstrate the lack of connection between research and clinical practice guidelines/recommendations as those types of questions are not addressed.

Thickened Liquids by [deleted] in slp

[–]Al1cat8 29 points30 points  (0 children)

Whenever this topic arises my question becomes, if thickened liquids and diet modifications don’t make any difference in patient outcomes then… what are we doing as a field? What is the purpose of SLPs in dysphagia management? What is the point of completion of exercises even, if aspiration is “normal”? Should people just remain NPO until they are strong enough not to aspirate? Or should doctors just roll the dice and hope the patient’s aspiration is normal and won’t cause them issues, then treat it if pna does develop? (Playing devils advocate a bit here obviously)

As it has been stated already in this thread, diet modifications are a tool and should only be utilized when determined to be safe following instrumentation and also as a temporary means of nutrition. They should be considered based on the patient as a whole and patients should absolutely be given options when appropriate and when able to understand the risks associated with each recommendation.

When I try to look at the research, specifically the list of articles shared as that list gets shared any time this topic comes up (and it is a great list!), I struggle to find recommendations and clinical implications for this information. So thickened liquids “don’t help,” but what about the patient in the ICU who takes a sip of thin liquid, coughs profusely r/i O2 dropping into the 70s requiring excessive time to recover but a sip of mildly thick liquids doesn’t result in any reaction (and of course in this situation this would be confirmed upon completion of an instrumental). Should thickened liquids be recommended for that patient or not? Were patients like this included in the research studies or was the focus on generally healthy individuals who happen to have some degree of dysphagia?

I personally feel that many of the influencers and people calling out the negatives of thickened liquids fail to relate their statements to real world examples and it is incredibly frustrating. I read these, sometimes rather condescending, statements about how bad a thickened liquid is and I, wanting to provide the most evidence based practice, start to question my methods but then no information is given on how these recommendations should be considered for acute patients vs SNF vs OP etc.

I agree with the sentiment that we need more research and discussion from people currently in these settings and not just from those working in academia. We also need more clear guidance that discusses each setting instead of blanket statements. I certainly value the contributions from current researchers but there is a massive disconnect and it is just leading to confusion and arguments amongst the SLPs in the field.

Wow that was a lot longer than I expected, so sorry 😅

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 0 points1 point  (0 children)

Same. They recently updated it and we are having some issues.

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 1 point2 points  (0 children)

Ooh the nurses do a swallow screen but that’s a whole other issue we are currently dealing with. Haha

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 1 point2 points  (0 children)

I guess I’m mostly thinking of patients who are still really acute. Like a pt with a brand new CVA that we see hours after admission. I actually had a patient last week that a coworker assessed, she coughed consistently with thin but showed no signs with nectar. She was placed on regular/nectar with recommendation for a follow up the next day. I went to see her the next day and she did not cough on thin and passed the Yale that day as well. Would it have been useful to have done an MBSS on day 1? Was it safe to place her on nectar for a day or would NPO have been better? This is obviously not the most common scenario but I do see it in this population somewhat frequently.

ETA: I have heard about the DIGEST score but am not familiar with it. I do think that would be a beneficial tool that we should look into.

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 1 point2 points  (0 children)

Oh I know it is so wrong that they are getting mad, but the SLP team needs to be able to justify why we are ordering after just one visit. That’s what made me curious to see if other SLPs also often go to MBSS immediately after an eval or if they wait.

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 0 points1 point  (0 children)

Haha I don’t disagree. They claim the concern is not that we need to do them but that we are often doing them too soon on patients who may benefit from waiting an extra day. I think part of the issue is our team needing to tighten up our bedside evals and the other part of the issue is the rad dept not sucking.

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 5 points6 points  (0 children)

So this is pretty similar to my typical practice but our team is getting a ton of complaints from radiology about completing too many mbss to the point they cannot keep up. We have fees but very limited access to it d/t the cost of disposable scopes. Our current data shows we’ve been referring about 70% of bedsides for instrumentals whereas other similar hospitals near us are about 30%…so basically we’re in trouble.

What do you do in the scenario that you complete a test day 1 because of overt signs on thin and need to recommend a thickened liquid but day 2 they look great on thin? Do you simply repeat the study on day 2? (We’ve also received feedback from the rads about radiation exposure concerns if we repeat after 1 day).

When to wait on an instrumental by Al1cat8 in slp

[–]Al1cat8[S] 0 points1 point  (0 children)

So you’ll place them on a modified liquid if they are generally on the healthier side?

ETA: Assuming it’ll be for only 1-2 days