Swallow Physiology and Pathology (497-0-1)
Instructors
Bonnie Jean Martin
Meeting Info
Frances Searle Building 1421: Mon, Wed 2:00PM - 3:20PM
Overview of class
Exploration of the anatomy and physiology of normal swallowing and the anatomic and physiologic disturbances affecting deglutition. Focus on recognizing clinical and radiographic signs and symptoms
of dysphagia and selection and implementation of treatment and management. Discussion
of ethical considerations. Emphasis on the integration of normative data, scientific knowledge, and clinical practice
Learning Objectives
Course Objectives:
1. Describe the essential components of swallowing physiology required for airway protection, swallowing efficiency and overall functional swallowing ability.
2. Identify peripheral and central neural control of swallowing physiology and pathophysiology of swallowing disorders
3. Understand the cross-system interactions (respiration, phonation, speech production) with swallowing throughout the upper aerodigestive tract.
4. Distinguish the purpose and scope of swallowing screening, clinical (bedside) assessment, and instrumental imaging examinations.
5. Contrast and select reliable and valid swallowing assessments and metrics based on the condition of the patient, clinical and environmental factors, nature of impairment, and clinical question.
6. List the advantages and examples of standardized assessment metrics and reporting methods for outcome tracking and clinician-to-clinician communication.
7. Implement a swallow screening, a clinical exam, and simulated MBSS and FEES.
8. Identify and distinguish the type and severity of physiological swallowing impairment(s) from instrumental examinations using the Modified Barium Swallowing Impairment Profile (MBSImP).
9. Determine and practice identification of the presence, cause, and response to airway invasion (penetration/aspiration).
10. Develop treatment plans using evidence based, targeted interventions through synthesis of principles of motor learning, clinical and assessment information.
11. Describe the potential adaptation and compensation patterns of the upper aerodigestive tract that can be identified during instrumental assessment in patients.
12. Develop a patient-centered, assessment and treatment report using SMART goals and prognostic statements.
13. Understand the importance of engaging patients and caregivers into the goal setting and management planning process.
14. Understand ethical considerations when formulating a dysphagia management plan.
15. Identify at-risk patient populations known to present with dysphagia and anticipate swallowing impairment based on the patients' clinical conditions and diagnoses (stroke and other brain injuries, neurodegenerative diseases, pulmonary disorders, head and neck cancers, structural abnormalities of the head and neck, frail elderly, gastrointestinal disorders).
16. Understand the impact of culture, diversity, and access on dysphagia patient care.
17. List reference sites and organizations for dissemination of dysphagia practice resources, patient and family support groups, and research publications.
18. Evaluate evidence in peer reviewed journal articles and information appearing in social media platforms.
Evaluation Method
Course Format:
· Didactic, In-Person Lectures
· Lab study
· Optional recordings to reinforce learning
· Two exams (Midterm and Final)
· Quizzes
· Readings
· In class discussion
MBSImP™ Self-study module:
This self-study, individually paced online learning module includes the MBSImP™ standardized training, practice and reliability testing for the identification and quantification of swallowing impairment toward targeted swallowing intervention. Students will have opportunity for interactive practice and immediate visual feedback as they progress through the training and testing.
MBSImP Module Objectives:
1. Demonstrate understanding and knowledge of the validated and standardized protocol (barium contrast materials including dose and task delivery, and patient instructions).
2. Identify and accurately rate the 17 validated physiologic swallowing components of oral, pharyngeal, and esophageal swallowing obtained from videofluoroscopic images during a Modified Barium Swallowing Study (MBSS) with ≥ 70% overall accuracy.
Class Materials (Required)
Required Materials:
· MBSImP™ online, student self-study module
· Manual: Standardized Training in Swallowing Physiology: Evidence-Based Assessment Using the Modified Barium Swallow Impairment Profile (MBSImP™) Approach
Materials are posted on Canvas
Other
- The Modified Barium Swallow Impairment Profile™ online training
- Standardized Training in Swallowing Physiology Manual
(Students will receive information about purchasing these items prior
to Winter quarter. The training and manual are highly (88%)
discounted for students)
Class Notes
Students will acquire knowledge of the anatomy, physiology, and neural underpinnings of normal oropharyngeal swallowing and pathophysiology of swallowing impairment (dysphagia) across the age continuum. Esophageal swallowing function and disorders will be introduced as they relate to the functional continuum of oropharyngeal swallowing impairment. Fundamental knowledge and skills will be gained for performing, interpreting, and reporting results from swallowing screenings, clinical evaluations, and instrumental evaluations including the Modified
Barium Swallow Study (MBSSs) and Flexible Fiberoptic Endoscopic Evaluation of Swallowing (FEES). High Resolution Manometry (HRM), respiratory-swallowing measurements, and impedance testing will be summarized.
Students will translate assessment finding to personalized, evidence-based treatments that include front line compensatory strategies, adaptations, strengthening, and skill-based rehabilitation approaches. Familiarization and practice with technology-assisted treatment approaches, and the incorporation of guided biofeedback will be provided. Principles of motor learning will inform the students' selection of swallowing rehabilitation approaches as they engage in real world cases of patients with dysphagia resulting from neurological disorders, head and neck cancers, pulmonary diseases, and aging.
Synthesis of acquired knowledge, skills, and clinical decision making will be assessed through the development of assessment and treatment reports including quantification and classification of dysphagia severity, development of prognostic statements, oral intake and diet consistency recommendations, selection of appropriate intervention approaches. Applied practice in formulation of treatment goals will be conducted using real-word patient cases, with consideration for clinical and environmental patient conditions, dysphagia severity, ethics, cultural diversity, and socioeconomic factors. Contemporary professional dysphagia practice matters, application of telehealth service delivery, ambulatory monitoring and research opportunities will be introduced.