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/

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

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.

speech therapy singapore

Our Online Speech Therapy or Telepractice Experience in Singapore during Covid-19

According to ASHA definition: https://www.asha.org/Evidence-Maps/
‘Telepractice is the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation.’

Telepractice for Speech Therapy has been proven to be effective and has been practiced in countries like the United States, Canada and Australia.

Our experience:
Since Covid-19 outbreak started, the acceptance of telepractice for speech therapy in Singapore has increased significantly especially during the circuit breaker period.

Our experience shows that it benefits most of our clients who require speech and language therapy, and to some of our clients who require swallowing therapy. We prefer to use Zoom Meetings for our telepractice. We find it easy to be used for 1-to-1 session as well as for group therapy sessions. Therapy tasks can to be shared and be viewed easily by our client(s). Clients are able to respond easily by indicating their answers on the screen by using the writing/drawing function. The Zoom file sharing function has allowed us to still customize and personalize each therapy sessions for our clients.

However, we need to take into consideration client’s proficiency level in technology. For clients who are less tech proficient, our experience shows that simple apps such as Facetime and Whatapp video call can work as well.

LATEST: On 24/4/2020, Facebook has just announced their videoconferencing function that allows video meeting up to 50 people without downloading any apps. That will open up another platform for telepractice.

For Speech-Language Therapists who would like to adopt Telepractice, you may refer to the following links for resources:

dysphagia research

Swallow with CTAR (S-CTAR) Poster presented at DRS 2017 @ Portland, Oregon

S-CTAR Poster

Life has been so busy since I came back from DRS 2017. Finally, I have some time to put up this blog.

I was honored to be invited to present a research poster at DRS this year.

This is probably one of the best year for dysphagia research representation from Singapore as we have 2 oral presentations from Singapore General Hospital and 1 poster presentation (presented by me) from National University of Singapore.

My poster presentation was on Swallow with Chin Tuck Against Resistance (S-CTAR). 

Some of the happy moments at DRS:

  • Portland, Oregon is really beautiful and … cold. 
  • Finally get a chance to meet my Facebook pal, Nabil from Canada in person. We share a common interest in dysphagia. Lots of interesting discussion on dysphagia via WhatsApp and Facebook messenger. 
  • Get to meet some old friends and made more new friends from all around the world. 
  • managed to take a selfie with Dr Reza Shaker!
  • Happy to know that CTAR or Chin Tuck Against Resistance is a well known and well like exercise in USA and Brazil. Brazil Speech Pathologists informed me that they have started research on CTAR! I really hope that clinical study on CTAR will be out soon. 
  • Most Speech-Language Pathologists were excited to know that S-CTAR can be used as a task specific exercise and foresee that they will use it in their dysphagia therapy or management. 
Portland Oregon
Portland, Oregon
Portland
Portland, Oregon
  • With Dr Shaker
    with Dr Reza Shaker
    Nabil = my FB Pal
    My FB Pal, SLP from Canada – Nabil
    Kotomi - SLP from Japan
    Kotomi Sakai – SLP from Japan
    Brazil SLP
    SLP from Brazil
    Poster presentation
    Demonstrating CTAR to a dentist from Japan
    Demonstrating CTAR & S-CTAR
    Demonstrating CTAR and S-CTAR
    I am a new DRS Member
    I am a new DRS member.
    Ironing sandwich
    This is new to me… Ironing sandwiches?!!!

    I was asked a few interesting questions on CTAR. One of the few interesting question is: are there any devices in the market that you think is good to be used to perform CTAR? I think this is an interesting question as we have seen quite a number of devices (different type of balls, hand held devices etc) being introduced to the market since the first paper on CTAR was published in 2014.

    Click  S-CTAR Poster to download the poster that I presented at DRS 2017.

    I will list out all those questions and answers in separate post soon. 

    To end this post, I would like to congratulate and express my appreciation to all the DRS committees for this successful and enlightening meeting. 

    Swallowing Problem

    How does dysphagia from mechanical obstruction sounds like?

    The following patient presents with dysphagia (swallowing difficulties) secondary to the presence of prominent anterior cervical osteophytes at the level of C3-C6, most prominent at C4.

    Dysphagia symptoms include:

    • Occasional coughing noted when eating solids as well as drinking fluids.
    • Multiple swallows per bolus

    I managed to record the patient’s usual swallowing sound using my IPhone 6s. Could this be the sound of mechanical obstruction?

    osteophytes
    MRI Cervical Spine shows cervical myelopathy. Prominent anterior cervical osteophytes from C3-C6.
    osteophytes label

    The sound of patient swallowing 10ml water recorded using an IPhone 6s. Note multiple swallows & loud squish sound.

    Dysphagia Therapy, Featured clinicians, Singapore, Swallowing Problem, Teaching, Uncategorized

    Workshop on ‘Best Practices in the Management of Oropharyngeal Dysphagia’

    Dear all,

    JurongHealth Speech Therapy department will be organising a 2 day workshop next year entitled ‘Best Practices in the Management of Oropharyngeal Dysphagia’. The workshop will be conducted by Dr. Catriona Steele and will be held on 20 – 21 May, 2016 at Ng Teng Fong General Hospital, Singapore.

    NTFGHJCHoverview
    NTFGH  

     

    About the speaker:

    Dr. Catriona M. Steele is a clinician scientist working in the area of swallowing and swallowing disorders. She has a background as a medical speech-language pathologist, and is Director of the Swallowing Rehabilitation Research Laboratory at the Toronto Rehabilitation Institute – University Health Network. Dr. Steele is a Professor in the Department of Speech-Language Pathology at the University of Toronto and is in demand as a teacher and workshop instructor around the world. Dr. Steele holds research funding from the National Institutes of Health (USA) and has more than 100 peer-reviewed publications.

     

    Brief outline of workshop

    > Best Practices in the Identification and Assessment of Oropharyngeal Dysphagia

    –   Sensitivity and specificity of different dysphagia screening tools

    –   Purpose, protocols and important technical considerations of videofluoroscopy

    – Using information from research to quantify observations during a clinical bedside swallowing assessment

    > Management and Rehabilitation of Oropharyngeal Dysphagia

    –  Evidence behind texture modification and postural approaches

    –  Direct and indirect swallowing/exercise approaches including the use of IOPI and sEMG biofeedback

    –  Other approaches in the literature: respiratory interventions, electrical stimulation, vibratory stimulation

     

    Estimated cost:  $400 – $500 per participant for the full workshop.

     

     

    Registration Correspondent: Ms Wong Wan Xin

    Wong Wan Xin| Speech Therapist, Rehabilitation | Ng Teng Fong General Hospital & Jurong Community Hospital | Jurong Health Services
    1 Jurong East Street 21, Singapore 609606 | T: (65) 67161674 | E: Wan_Xin_Wong@juronghealth.com.sg

    dysphagia assessment, Dysphagia Therapy, SHAS, speech therapy singapore, speech-language therapy, Swallowing Problem

    SHAS SIG : Sharing on Paediatric Feeding Services Available in Singapore

    Host: Speech-Language and Hearing Association Singapore (SHAS)

    The SHAS will be holding a Special Interest Group : Sharing on Paediatric Feeding Services Available in Singapore

    Date: 26 November 2015 (Thursday).

    Venue: KK Women’s and Children’s Hospital, Women’s Tower (Level 1), Seminar Room 1, 100 Bukit Timah Rd, Singapore 229899

    There will be sharing session by various representatives from different organisations:

    • Cerebral Palsy Alliance Singapore
    • KK Women’s & Children’s Hospital
    • National University Hospital
    • Rainbow Centre
    • Thomson Paediatric Centre

    SHAS paediatric feeding
    If you are interested in attending the session, please email the completed registration form to pd.shas@gmail.com by 20 November 2015 (Friday). 

    Dysphagia Therapy, speech therapy singapore, speech-language therapy, Swallowing Problem

    Workshop on Dysphagia Management: NMES / sEMG Guardian Way in Hong Kong

    Guardian Way Workshop

    Workshop on Dysphagia Management: NMES / sEMG Guardian Way

    Instructors: Teresa Biber, M.S., CCC-SLP

    Nancy Calamusa, MA, CCC-SLP

    Date: 26-27 September 2015 (NMES / sEMG Guardian Way)

    Date: 28 September 2015 (Paediatric Workshop)

    Venue: Kowloon Bay International Trade and Exhibition Centre (KITEC) Room 631, Hong Kong

    Contact:  GSBE Company Ltd at 9190-0180 or or GSBECOMPANYLTD@GMAIL.COM

    Co-organizer: SpectraMed, Inc. and GSBE Company Ltd

    Please refer to attached registration forms for details.

    pdf_SEPT2015_Form

    pdf_SEP2015_GuardianWay

    pdf_Paed_Workshop_SEP2015