It’s More than Just Swallowing – Examining Breathing, Digestion, and Deglutition

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Handouts/Brochure

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Angela Mansolillo, MA/CCC-SLP, BCS-S Related seminars and products

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Angela Mansolillo, MA/CCC-SLP, BCS-S, is a speech-language pathologist and board-certified specialist in swallowing disorders with more than 30 years of experience. She is a senior speech-language pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she provides evaluation and treatment services for adults and children with dysphagia and is involved in program planning and development including quality improvement initiatives, patient education, and clinical policies and protocols. She is also adjunct faculty at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts and a guest lecturer in the Department of Communication Disorders at the University of Massachusetts. Over the course of her career, she has worked in a variety of clinical settings with children and adult populations with a career-long focus on feeding and swallowing disorders. Recently, she authored Let’s Eat!: A Clinical Guide to the Management of Complex Pediatric Feeding and Swallowing Disorders. Angela is a recent recipient of the Massachusetts Speech and Hearing Association’s Award for Clinical Excellence and is a sought-after speaker for both live and online continuing education courses as she seamlessly blends current research with clinical experience.

 

Speaker Disclosures:
Financial: Angela Mansolillo has an employment relationship with Elms College and Cooley Dickinson Hospital. She is a consultant with Dysphagia Services and receives speaking honorarium from ContinuEd, Medbridge, Advantage CE, and Dilgem Continuing Education. Angela Mansolillo receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Angela Mansolillo is a member of ASHA.

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Objectives

1. Use your understanding of the interrelationships between the respiratory and gastrointestinal systems to identify and treat the causes and not just the symptoms of dysphagia in your pediatric and adult clients.
2. Evaluate the impact of respiratory and gastrointestinal functions on swallowing systems in order to choose targeted interventions and increase your effectiveness in reducing aspiration risk.
3. Design effective multi-disciplinary treatment plans for clients with respiratory and GI disease processes including COPD, respiratory failure, and GERD.
4. Expand your diagnostic tool box to include cough testing, water screenings, pulse oximetry, respiratory muscle strength testing, sensorimotor assessment, and other evidence-based tools.
5. Develop successful treatment plans by identifying reflux disease and its impact on swallowing function in your clients.
6. Design assessment strategies that allow you to identify those clients who are more likely or less likely to get sick as a result of aspiration

Outline

Breathing/Swallowing Coordination
Respiratory System

• Anatomy and physiology
• Coordination and aspiration
• Airway protective mechanisms
• Impact of various respiratory diseases

Gastroesophageal System

• Esophageal and digestive functions
• GERD and feeding/swallowing difficulties
• Reflux mechanisms
• Esophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS   
What’s the connection?

• Pressure, energy, and innervation
• Extra-esophageal reflux
• Aspiration and the Airway
• Risk factors for pneumonia
• Aspiration and Oral Hygiene – It Takes a team

Disease Processes and Impact on Breathing, Digestion, and Swallowing

• Airway Management, biopsychosocial factors, and implications for feeding and swallowing
  • Intubation, tracheostomies, nasal cannula and more
  • Implications for feeding

Reflux, biopsychosocial factors, and implications for feeding and swallowing

• Interpreting test results and implications for treatment
• Lifestyle factors

Swallow Assessment

Determine Aspiration Risk

Cognitive, Sensorimotor, and Respiratory Muscle Strength Assessment Tools

3 oz Water Test, Pulse Oximetry and More

Understanding lab values

Instrumental assessment:

• Modified barium swallow studies
• Fiberoptic endoscopic evaluation of swallowing

Feeding Interventions

• Multisensory cues
• Utensil selection
• Environmental modifications
• Assisted feeding options
• Feeding schedules
• Behavioral interventions

Aspiration Management
Diet modifications – Not such a benign intervention

• Implications of dietary changes
• Compliance issues
• Thick liquids – pros and cons
• Water protocols

Strategies and Exercises – What does the evidence tell us?

• Compensation
• Sensory interventions
• Principles of exercise physiology
  • Motor learning principles
  • Exercise dose
  • Skill training vs strengthening
  • Biofeedback
• Lingual strengthening
• Pharyngeal strengthening
• Expiratory muscle strength training
• Modifications and adaptations: impairment specific strategies

REFLUX ASSESSMENT
What do these tests tell me?

• Upper GI studies
• Ph Monitoring
• Esophagoscopy
• Scintigraphy

REFLUX MANAGEMENT
What’s the dysphagia clinician to do?

• Lifestyle modifications
• Positioning
• Diet modifications
• Medications
• Effects of acid suppression
• Surgical interventions
• New directions in reflux management
   

Target Audience

• Speech-Language Pathologists
• Speech-Language Pathology Assistants
• Occupational Therapists
• Occupational Therapy Assistants
• Respiratory Therapists
• Nurses
• Nursing Assistants
• Restorative Nursing Staff
• Dietitians
• Dietary Managers
• Long-Term Care Professionals

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