SUMMER ABROAD PROGRAM 2008

AT

LUND UNIVERSITY

NEW YORK UNIVERSITY

STEINHARDT SCHOOL OF CULTURE, EDUCATION, AND HUMAN DEVELOPMENT

DEPARTMENT OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY

Dysphagia in Children and Adults (E34.2060)

Professor Celia Stewart

Office Hours: Before, after class, and on an as needed basis.

Please come to class on time and take care of all personal needs before class begins.

Objectives: This course builds a working knowledge of the normal anatomy and physiology of the swallowing mechanism for children and adults and the breakdowns in swallowing that can result from neurological, structural, and behavioral disorders. The course will focus on building the ability to interpret the results of bedside, radiographic, and fiberoptic studies of the manipulation and swallowing of boluses and to select appropriate treatment strategies. This course will focus on developing problem solving skills needed to identify elements in each patient’s history and clinical assessment relevant to the patient’s dysphagia, to determine and plan the best instrumentation and evaluation procedures, and to plan appropriate interventions to restore safe and efficient oral intake as quickly as possible.

Texts: Logemann, J.A. Evaluation and Treatment of Swallowing Disorders. Austin, Texas: Pro Ed. 2nd edition, 1998.

Hall, K.D. Pediatric Dysphagia: Resource Guide. San Diego, California: Singular. 2001; ISBN 0-7693-0063-4

COURSE SYLLABUS – Class meets from 9:00-11:00 AM

Tuesday, May 27 / Introduction to course; Scope of course; Requirements; Anatomy and physiology of normal swallowing
For tomorrow: Read Chapters 1 & 2 in Logemann and label a drawing of sagittal view of head.
Wednesday, May 28 / Anatomy and physiology of normal swallowing (continued) and Assessment of Swallowing
Drawing of sagittal view of head with labels is due today (10 points)
For tomorrow: Read Chapters 3,4,5,7,8,9,&10 in Logemann
Thursday, May 29 / Travel to Stockholm
Friday, May 30 / Stockholm, Karolinska. Kerstin Johansson
For next week: Read Chapters 12&13
Tuesday, June 3 / Assessment of Swallowing (continued)
For tomorrow: Read Chapter in Logemann
Wednesday, June 4 / Assessment of Swallowing (continued)
Quiz of anatomic structures (20 points)
For tomorrow: Read Chapter 5,6&11 in Logemann
Thursday, June 5 / Fees, Per Svensson
Monday, June 9 / The Dysphagia Team at Malmö University Hospital, Diagnostic Centre entrance 44
Tuesday, June 10 / Assessment of Swallowing (continued)
Wednesday, June 11 / Midterm Examination
Wednesday, June 18 / Management of the patient with oropharyngeal swallowing disorders and Management of the patient with swallowing disorders resulting from cancer and other structural disorders
Write-up of normal dysphagia examination is due today (5 points)
For tomorrow: Read Chapter 14 in Logemann
Thursday, June 19 / Center for Rehabilitation of Brain Injury, University of Copenhagen
Friday, June 20 / Swallowing disorders caused by neurological lesions, degenerative disease, and medical treatment
Project # 3 In class ~ Videoflorospocic Assessment of Swallowing Project
For tomorrow: Read Sections 2&3 in Hall
Monday, June 23 / Child anatomy and physiology and swallowing disorders in children
For tomorrow: Read Section 4 in Hall
Write-up of videofluoroscopic dysphagia examination is due (25 points)
Tuesday, June 24 / Child dysphagia and Clinical decision-making; Multidisciplinary management of dysphagia; Ethical issues and feeding
Wednesday, June 25 /
Cumulative Final Examination

Evaluation of Student Success:

1. Performance on quizzes, examinations, and projects

2. Performance on identification of swallowing disorders and treatments


Course Information

Late assignments are not accepted.

Students with Disabilities

Any student attending NYU who needs an accommodation due to a chronic, psychological, visual, mobility and/or learning disability, or is Deaf or Hard
of Hearing should register with the Moses Center for Students with Disabilities at 212 998-4980, 240 Greene Street, www.nyu.edu/csd.

Missing a test without receiving explicit verbal permission from the instructors personally beforehand will automatically drops the grade 10%. Makeup exams will be given only at the instructor’s discretion and convenience, provided that there is a good and compelling reason for your absence. Leaving a message on an instructor’s voice mail or sending an e-mail does not constitute receiving verbal permission unless there has been a response.

Source Material: The information for this course will be covered primarily in the lectures and associated handouts. Please use the text as an additional reference and/or contact the instructor with any additional questions.

ASHA/CAA KASA Goals addressed in this course:

Standard III-B - The applicant must demonstrate knowledge of basic human swallowing processes, including their biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases in the following areas: biological, neurological, psychological, development/lifespan, cultural, biological, neurological, and acoustic.

Standard III-C - The applicant must demonstrate knowledge of the nature of disorders and differences and swallowing, disorders, including the etiologies, characteristics, anatomical/physiological, acoustic, psychology, developmental, and linguistic and cultural correlates. Specific knowledge must be demonstrated in the areas of swallowing (oral, pharyngeal, esophageal, and related functions, including oral function for feeding orofacial).

Standard III-D: The applicant must possess knowledge of the principles and methods of prevention, assessment, and intervention for people with swallowing disorders, including consideration of anatomical/physiological, psychological, developmental, and linguistic and cultural correlates of the disorders

Standard IV-G: The applicant for certification must complete a program of study that includes supervised clinical experience sufficient in breadth and dept to achieve the following skills outcomes (in addition to clinical experiences, skills may be demonstrated through successful performance on academic course work and examinations, independent projects, or other appropriate alternative methods).

Labeling a Sagittal Head (10 points)
Each student will label the structures listed below on a cartoon of the sagittal (lateral) view of a head.
·  Anterior Commissure of vocal folds
·  Arytenoid cartilage
·  Conus elasticus
·  Cricoid cartilage
·  Epiglottis
·  Esophagus
·  False vocal fold
·  Hard palate
·  Hyoid bone
·  Lingual tonsil
·  Nasal sinus
·  Pharynx
·  Soft palate
·  Spinal column
·  Thyroid cartilage
·  Tongue
·  Trachea
·  Vestibule in Larynx
·  Pyriform sinus
·  Valleculae
Objective:
To help students develop skills for recognizing the anatomic structures of modified barium swallow studies.
Grading:
½ point will be given for each structure that is labeled correctly.
Quiz of Anatomic Structures (20 points)
Students will have a quiz on the structures on September 27.
Objective:
To help students develop skills for recognizing the anatomic structures of modified barium swallow studies.
Grading:
One point will be given for each structure that is labeled correctly.
Clinical and Radiographic Examination of Dysphagia
Students will practice the skills learned in this course while viewing tapes of individuals with dysphagia. They will be required to write paragraphs describing the dysphagia symptoms of patients viewed in class. They must describe the overall severity, oral preparatory, oral, pharyngeal and esophageal phases of the swallow and comment on the different food consistencies using the framework and model described in this course. Students will identify an appropriate course of therapy for the patient including diet, positioning and strengthening exercises. Students will be selected randomly to read the write-ups in class
Objectives:
To help students develop their
1.  Analysis of perceptual features of abnormal speech production.
2.  Professional writing skills.
In Class Swallowing Examination (5 points)
Students will be required to practice the skills learned in this course by performing swallowing examinations on each other. They will write up the examination using the appropriate framework and model to describe all phases of the swallow that can be evaluated with a clinical examination of swallowing. The paragraph must comment on the food consistencies that were evaluated. If the student requests, the report can be rewritten with a 1 point deduction for each additional submission.
Objectives:
To help students develop skills for identifying the stages in swallowing, awareness of food textures, and professional writing skills.
1. Be sure to make a statement about the overall severity of the problem.
2. Organize all of the information by stage. Do not describe one stage at one time and then go on to other stages and then return to the first stage. Keep all information about each stage together.
3. Describe all disorders that you observe fully. Note the % of the bolus that was aspirated and when the aspiration occurred. Describe the location of the pooling, if it clears, and how much of the bolus is pooled. Is the range of movement for the structures appropriate? Why is there aspiration?
4. What is the problem that the person is having with each stage? Check the table on page 122 for guidelines.
5. Before your recommend a texture of food, head posture, or swallowing maneuver, you need to test them under videofluoroscopy to make sure that they help.
The assessment will be graded based on the following criteria:
·  Followed model - One short well-organized paragraph describing swallowing examination on a normal individual (1 point)
·  Appropriate and complete swallowing analysis with complete information for describing the oral preparatory, oral, pharyngeal and esophageal phases of the swallow. (2 points)
·  Appropriate and complete description of the different food consistencies that were used (1 point)
·  Professional writing, grammar, and conciseness (1 point)
Write up of Radiographic Evaluation of Swallowing (25 points)
Students will practice the skills learned in this course while watching videofluoroscopic tapes of individuals with dysphagia. They will be required to perform write ups on videos of patients with dysphagia viewed in class. They must describe the overall severity, oral preparatory, oral, pharyngeal and esophageal phases of the swallow and comment on the different food consistencies using the framework and model described in this course. Students will identify an appropriate course of therapy for the patient including diet, positioning and strengthening exercises. Students will be selected randomly to read the write-ups in class. If the student requests, the report can be rewritten with a 1 point deduction for each additional submission.
Objectives:
To help students develop their:
1.  Analysis of features of dysphagia.
2.  Professional writing skills.
The assessment will be graded based on the following criteria:
·  Followed model - One short well-organized paragraph describing swallowing examination on a normal individual (5 points)
·  Appropriate and complete swallowing analysis with complete information for describing the oral preparatory, oral, pharyngeal and esophageal phases of the swallow (5 points)
·  Appropriate and complete description of the different food consistencies that were used (5 points)
·  Appropriate course of therapy for the patient (be sure to include diet, positioning and strengthening exercises) (5 points)
·  Professional writing, grammar, and conciseness (5 points)

Food consistencies:

Thin liquid

Nectar

Honey

Spoon thick

Puree

Soufflé

Mechanical soft

Regular