Updates

Public awareness

FB Presentation Video and Handouts: Speech, swallowing and hearing difficulties in nasopharyngeal cancer (NPC) before, during and after radiotherapy. Why and how to manage ok?

Speech Therapy Works and Singapore Swallowing Specialists collaborated with 20dB Hearing Sdn Bhd, Malaysia to present this interesting topic Live on Facebook on 22 July 2020 at 8.00pm (SGT).

We had audiences from all around the world. Great questions were asked during the presentation. Feedback on the live presentation has been good.

Speech Therapy Works and Singapore Swallowing Specialists will organize more Live Facebook presentation in future. Topic would include speech, language and swallowing difficulties for stroke / dementia / neurodegenerative diseases including Parkinson’s disease and etc. Do follow our blog or Facebook to receive notification on the future Facebook Live presentation.

We are happy to announce that the president from the OneHeart Support Group (A Nasopharyngeal Cancer support group in Singapore) has opened their support to individuals or cancer survivors especially the NPC survivors. OneHeart Support Group will provide emotional and psychological support. For those interested to seek support from OneHeart, please contact Dave at +65 9101 8223. We will include a copy of OneHeart Support group brochure in this post once we receive it.

Please see attached for the handouts for this presentation.

Dysphagia Training

Free Webinar: Introduction to the IOPI System

Home - IOPI Medical
https://iopimedical.com/

IOPI 101: Introduction to the IOPI System

Hosted by: Ed Bice, M.Ed., CCC-SLP

This 1-hour webinar, hosted by Ed Bice, M.Ed., CCC-SLP, introduces participants to the IOPI Pro and IOPI Trainer, demonstrates the standard methods for measuring tongue and lip strength and endurance, and explains how to use this system for biofeedback during exercise.

Schedule

DateTime (Click/press to convert)DurationRegistration Link
Thurs. July 9th1:00 pm PT / 4:00 pm ET1 hourRegister
Tues. July 14th10:00 am PT / 1:00 pm ET1 hourRegister
Thurs. July 23rd8:00 am PT / 11:00 am ET1 hourRegister
Tues. July 28th3:00 pm PT / 6:00 pm ET1 hourRegister
Dysphagia Training

NFOSD Dysphagia Webinar Series: Transitional Foods – Updates on Their Behavior, Use and Benefits in Adult & Pediatric Populations

Date and time: Thu, Jul 23, 2020 8:00 AM – 9:30 AM SGT

Webinar Description:  

This webinar is for healthcare providers, patients and caregivers impacted by dysphagia, and students learning about swallowing disorders.

This presentation will define and categorize types of transitional foods.  We will discuss the potential benefits of improved choices, increased textures and ultimately improved dining enjoyment. Use of transitional foods in the pediatric population will be discussed with examples of use presented in specific special needs populations. The IDDSI testing method for transitional foods will be reviewed and the variation in results obtained with this test will be demonstrated between known transitional foods. We will share two research methods of evaluating the dissolution patterns of transitional foods in the oral environment will be described with relevant clinical implications.  The external environment (air, humidity, length of exposure) play a significant role in the transitional behavior of these foods and ultimately their safety. The oral environment (amount of saliva, degree of tongue pressure, anterior-posterior transit time) also has a significant impact as well.  Both groups of factors will be discussed in detail providing a broader scope of understanding of patient selection, and proper use.  Ultimately expanding our knowledge of transitional foods will improve our understanding of use with the goal of improving patient engagement and outcomes.

Learner Outcomes: 

  • Understand the difference between transitional food behaviors in the mouth in comparison to  IDDSI benchtop methods.
  • Classification of transitional foods and the importance of the oral environment
  • Learn the role transitional foods can play in dysphagia management

Click here to register of the Free Webinar: https://swallowingdisorderfoundation.com/webinar-transitional-foods/

swallowing therapy

Latihan Menelan (Dysphagia Therapy) Chin Tuck Against Resistance / CTAR dengan Bola Getah

Video latihan menelan Chin Tuck Against Resistance / CTAR
GDM would like to express our heartfelt thanks to Ms Siti Amirah for her help in translation of the Malay Version of the CTAR video.

Video latihan menelan Chin Tuck Against Resistance / CTAR ini merupakan video Bahasa Melayu pertama yang dihasilkan oleh Singapore Swallowing Specialists.

Chin Tuck Against Resistance (CTAR) dengan Bola Getah

Tujuan: Untuk menguatkan otot suprahyoid yang digunakan semasa menelan. Otot-otot suprahyoid penting untuk membuka sfinkter paip makanan atas anda (sfinkter esofagus atas) untuk membolehkan makanan memasuki perut anda.

 Peralatan: 1) Bola getah, 2) jarum pam udara dan pam udara (pilihan) – untuk meningkatkan diameter dan tekanan bola

 Arahan:

 Bahagian 1: CTAR berkekalan (Isometrik)

  • Duduk / berdiri tegak dan tarik bahu ke belakang.  Kekalkan postur ini semasa latihan.
  • Pegang bola di bawah dagu dengan tangan anda dan kekalkan posisi bola sepanjang latihan.
  • Tundukkan dagu anda pada bola sekeras mungkin; dan kekalkan  selama _______ saat.
  • Ulangi _______ set seperti yang disyorkan oleh terapis / patologis pertuturan anda.
  • Rehat selama 1 minit di antara setiap set latihan.

 Bahagian 2: CTAR berulang (Isokinetik)

  • Duduk / berdiri tegak dan tarik bahu ke belakang.  Kekalkan postur ini semasa latihan.
  • Pegang bola di bawah dagu dengan tangan anda dan kekalkan posisi bola sepanjang latihan.
  • Tundukkan dagu anda, sekeras mungkin pada bola;  kemudian angkat dagu.
  • Ulangi langkah di atas untuk ________ kali dan set ________ seperti yang disyorkan oleh terapis / patologis pertuturan anda.
  • Rehat selama 1 minit di antara setiap set latihan.

Klik pada yang berikut untuk memuat turun (download) arahan latihan:

CTAR with Rubber Ball Exercise videos are available in the following languages:

* Click to view CTAR videos in the following languages.

Chin Tuck Against Resistance (CTAR) exercise is suitable for most patients with swallowing difficulties / dysphagia:

  • dysphagia or swallowing difficulties following strokes,
  • dysphagia following head and neck cancer,
  • dysphagia following Parkinson’s disease,
  • dysphagia due to late effect of radiotherapy i.e. Nasopharyngeal cancer
  • etc.
Dysphagia Training

Free Webinar by NFOSD: Managing Dysphagia in Adults with Intellectual Disability

Date and Time: Wednesday, June 17, 5:00 pm Pacific (June 18, 8.00am Singapore / Malaysia / Philippine )

Webinar Description:  

Adults with intellectual disability are at risk for dysphagia.  The unique swallowing, feeding, and behavioral challenges experienced in this population are vital considerations in the assessment and treatment of these patients.  This webinar will discuss the nature of dysphagia management in adults with intellectual disability by exploring the current evidence in this area and discuss the clinical experiences of speech pathologists who assess and treat adults with intellectual disability in the Intermediate Care Setting.

At the completion of this webinar, participants will:

  • Understand the impacts of dysphagia in people with intellectual disability
  • Identify the systems that must be considered in the assessment and treatment of dysphagia in those with intellectual disability
  • Anticipate the physical-nutritional needs of those with intellectual disability as they age
  • Describe the interdisciplinary team collaborations required to manage dysphagia in this population

Click here to register for the FREE webinar:

https://register.gotowebinar.com/register/76969519229535757

NFOSD website:

Dysphagia & Special Populations: Managing Dysphagia in Adults with Intellectual Disability

swallowing therapy

(Recommended article) Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

Mark A. Fritz · Rebecca J. Howell · Martin B. Brodsky · Debra M. Suiter · Shumon I. Dhar · Anais Rameau · Theresa Richard · Michelle Skelley · John R. Ashford · Ashli K. O’Rourke · Maggie A. Kuhn

Abstract
Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workfow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients sufering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.

Click here to access full article (Open access):

Dysphagia
https://doi.org/10.1007/s00455-020-10144-9

Uncategorized

How COVID-19 Swab Test is done? A Singapore Speech Therapist’s experience

In this video, I will show you how a COVID-19 swab test is done and I will explain how it feels like.

Is it necessary for Speech Therapist to go through COVID-19 swab test?

We feel that it is very important for speech therapists / pathologists in Singapore to go through the COVID-19 swab test. As this will not just boost clients’ confidence but also to ensure safety especially when it comes to physical visits such as home or clinic speech or swallowing therapy sessions.

All our speech therapists at Singapore Swallowing Specialists and Speech Therapy Works, Singapore have undergone COVID-19 swab testing, and we have all tested negative.

swallowing therapy

Dysphagia Swallowing Therapy – Chin Tuck Against Resistance (CTAR) with Rubber Ball

Video on CTAR by using the rubber ball

Singapore Swallowing Specialists (SSS) network has just released their very first swallowing therapy video on Chin Tuck Against Resistance (CTAR) by using the rubber ball (Series 1). We plan to produce more series on CTAR and other swallowing therapy exercises / strategies and translate all the videos to different languages from around the world. SSS hope to reach out to benefit more people worldwide.

The following is the CTAR exercise instructions. You may download a PDF copy of this instructions at the bottom of this page.

For clinicians, you may download the above QR code and print it on your exercise handouts to facilitate clients’ search for the above YouTube Video.

Chin Tuck Against Resistance (CTAR) with a Rubber Ball

Purpose: To strengthen the suprahyoid muscles used in swallowing. The suprahyoid muscles are important to open your upper food pipe sphincter (upper esophageal sphincter) to allow food to enter your stomach.

Equipment: a)Rubber ball, b)Air pump and ball pump needle valve (optional) – to increase diameter and pressure of the ball

Instructions:

Part 1: Sustained CTAR (Isometric)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Sustain chin tuck against the ball for as hard as possible; for the duration of _______ sec.
  4. Repeat _______ sets as recommended by your speech therapist / pathologist.
  5. Rest for 1 minute in between each set of the exercise.

Part 2: Repetitive CTAR (Isokinetic)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Tuck your chin in, as hard as possible against the ball; then lift your chin.
  4. Repeat the above steps for ________ times and ________ sets as recommended by your speech therapist / pathologist.
  5. Rest for 1 minute in between each set of the exercise.

Click on the following to download the exercise instructions and/or the QR code to access the YouTube video:

YouTube video URL: https://youtu.be/zBoZSr19zWo

CTAR with Rubber Ball Exercise videos are available in the following languages:

* Click to view CTAR videos in the following languages.

Chin Tuck Against Resistance (CTAR) exercise is suitable for most patients with swallowing difficulties / dysphagia:

  • dysphagia or swallowing difficulties following strokes,
  • dysphagia following head and neck cancer,
  • dysphagia following Parkinson’s disease,
  • dysphagia due to late effect of radiotherapy i.e. Nasopharyngeal cancer
  • etc.
Swallowing Problem

Swallowing Therapy Tip: How to Speed Up the Thickening of Nutritional Supplement

Thickening of Resource 2.0 to honey consistency with Nestle Resource ® ThickenUp® Clear

Speech therapists / pathologists in Singapore and around the world assess swallowing with different fluids or diet consistencies. Once the swallowing assessment is carried out, speech therapists will usually prescribe diet and fluids consistencies that are suitable / safer based on the assessment findings. When thickened fluids are recommended, caregiver training on thickening of fluids to the recommended consistency will usually be performed.

One of the common challenges faced by many speech therapists, nurses and caregivers is thickening of nutritional supplement with thickener. I did a search online and found out from the Resource ® ThickenUp® Clear official website (https://www.thickenupclear.com/products/resource-thickenup-clear) that it takes milk and oral nutrition supplements up to 15 minutes to reach desired consistency. It is just too time consuming to prepare thickened supplement.

I might have a way to speed up the thickening of nutritional supplements!

Many years ago, I did a project for a nutritional company in Singapore on thickening of nutritional supplement using Xanthan gum thickener (the brand that I was using in the project was Nestle Resource ® ThickenUp® Clear). I came out with the following “Manual Shake” method to thicken up the nutritional supplement (** However, this method does not work on fruit juice-based supplement). I did a quick search on google but could not find any and not sure if any speech therapists / any institutions in the world are using this method.

We have used this method to thicken up supplement in some hospitals and it has successfully reduced the timing of thickened supplement preparation time. With this method, thickening of supplement process can be achieved within 2 minutes. The thickened supplement remains stable even after 10 minutes. In the following videos (taken in 2015), I show the process of thickening of Nestle Resource 2.0 and Nestle Isocal to honey consistency (moderately thick consistency) and the consistency remains stable after 5 minutes or longer. For Nestle Resource 2.0 and Nestle Isocal, I followed the thickener dosage as listed on Nestle Resource ® ThickenUp® Clear can or dosage chart: https://www.thickenupclear.com/products/resource-thickenup-clear

You can try to use this ‘Manual Shake’ method to thicken up other nutritional supplement but the thickness might vary. I would suggest to trial and error to find out the amount of thickener required for the nutritional supplement(s) that you are using in your hospital. For patient(s) who intend to use this method to thicken up your supplement, please consult your speech therapist/pathologist for advice on the consistency and the amount of thickener powder that might be required.

As the video was done in 2015, I did not do an IDDSI (International Dysphagia Diet Standardization Initiative) flow test on the texture. We just started following IDDSI standard in Singapore and we are planning to conduct another research on this soon. For speech therapists, or dietitian or healthcare professionals who would like to ensure that the texture meet the IDDSI standard, I would suggest that you perform your own IDDSI flow test and I would be grateful if you could share with me or others. You may email me at speechtherapyworks@gmail.com and I would be most happy to post it on my blog.

I collaborated with the nurses in St Luke’s Hospital, Singapore to run a project on thickening of nutritional supplement and the project won 2 quality improvement award and the research poster was presented the International Forum on Quality and Safety in Healthcare, Taipei in 2019.

Jose, R., Rendom, J., Yoon, W.L., Abillar, L., Low, P.S., Su, A.Q., (2019 September). New Practices in Thickener Mixing for Effective Care. Poster session presented at c

Awarded:

  • Agency for Intergrated Care (AIC) Quality Improvement Award (2018)
    • St Luke’s Hospital Clinical Quality Improvement Merit Award (2017)

Here are the steps to thicken up nutritional supplement (non-juice based supplement):

  1. Measure the amount of supplement in a measuring bottle (I would recommend to use a measuring bottle or cup with cover that allows you to shake and serve / drink from)
  2. Mix the amount of thickening powder (Xanthan Gum) required as your stir the supplement.
    • For Nestle Resource 2.0 and Nestle Isocal, I follow the thickener dosage as listed on Nestle Resource ® ThickenUp® Clear can or dosage chart: https://www.thickenupclear.com/products/resource-thickenup-clear
    • Yes, the way I mix it is different as compared to the method recommended by Nestle Resource ® ThickenUp® Clear. Either way of mixing is fine. The reason I mix it the way I did was because it is not easy to ensure that the cup is always dry and pouring in thickener powder into wet cup might cause clump formation.
  3. Cover the bottle / cup and shake it for approximately 2 minutes. *You will feel the gradual thickening up and the slowing of flow of the supplement as your shake the mixture.
  4. Open up the cover and serve / drink. Please ensure safety in drinking the thickened supplement by following the strategies that have been recommended by your speech therapist/pathologist.

I hope you will find this ‘manual shake’ supplement thickening method useful. Please like and share with your friends and others so that the information will reach to those who might needs it.

I will post more useful information on dysphagia from time to time. Please follow my blog and like my Facebook at https://www.facebook.com/SGSwallowingSpecialists/

Please feel free to email me at speechtherapyworks@gmail.com if you have any questions.

Thickening of Resource 2.0 to honey consistency with Nestle Resource ® ThickenUp® Clear
Thickened Isocal and Resource 2.0 remain stable after more than 5 minutes

Disclaimer: When choosing food thickeners or nutritional supplements/beverages, please consult with your speech therapist/pathologist or dietitian or health care professional as to what product is appropriate for your individual needs, as consistencies vary between nutritional supplements and manufacturers. As this method is not tested using IDDSI method, health care professionals who would like to adopt this method are encouraged to perform IDDSI flow test to ensure that the thickened supplement(s) of different brands meet the standard.

Public awareness

Covid 19: Tip to reduce or prevent ear pain from prolonged masks wearing

Pain or itching on ear caused by mask straps

Pain or itching on the ear caused by mask straps from prolonged mask wearing has been a common complaint.
There are many custom made “ear saver” ideas that you can find from Google. Some people are selling these ideas, you may be familiar with the term “mask strap extender”.

‘Ear saver ‘ ideas from Google

Personally, I have tried using a paper clip and it was not very comfortable.
After some experimenting, I have found a design that I would like to share with you to help you make a comfortable “ear saver”.

Here in Singapore, I have taught some of the healthcare professionals and food sellers to make this “ear saver” and the feedback has been good.

The materials required are simple. Just use an elastic band or string!

Tie both mask straps together with the elastic band/string and customise it to a length you are comfortable with.

Just found out another great ‘ear saver’ idea by my Japanese friend Ms Kotomi Sakai.

DIY Ear Saver by Ms Kotomi Sakai using spiral hair tie