What Is “Usual Care” in Dysphagia Rehabilitation: A Survey of USA Dysphagia Practice Patterns.

What is “Usual Care” in Dysphagia Rehabilitation: A Survey of USA Dysphagia Practice Patterns.

Dysphagia. 2013 May 14;
Carnaby GD, Harenberg L

The scope of dysphagia rehabilitation has been expanding. Therapeutic approaches have begun to move away from the use of behavioral compensations and maneuvers only, toward a greater emphasis on research-supported exercise-based therapies. Given the change in focus and demand for evidence-based practice, this study surveyed licensed speech language pathologists who treat dysphagic adults to ascertain the utilization of exercise-based techniques and supportive research in treatment decision-making. A web-based survey was created using Qualtrics online software. The survey consisted of 29 questions on demographics and treatment options for a deidentified patient in a video-supported fictional scenario. Initially, a field test was conducted by sending the survey to a sample population of 12 local speech pathologists working in adult dysphagia rehabilitation. Responses were collated and analyzed for item agreement and internal consistency. A blast e-mail containing a link to the modified survey was then sent out to members of the American Speech Language Hearing Association Special Interest Group 13. Participants were given 2 months to complete the survey. A total of 254 responses were analyzed using descriptive, correlative, and associative methods. Respondents were experienced speech-language pathologists (SLP) working in primarily acute and rehabilitation settings and treating more than 50 dysphagic cases in a 6-month period. They reported treating dysphagic patients daily for an average of 30 min a session. Follow-up of treated patients was infrequent. Most respondents reported using self-developed assessment techniques, and as a group they recommended 47 different treatment techniques and more than 90 different treatment combinations for the same hypothetical patient case. The majority of respondents also described the common outcome of dysphagia treatment as returning a patient to a safe and functional oral diet, but not preinjury status. Results demonstrate a lack of uniformity in the treatment schemes and strategies used by SLP to treat dysphagic patients. The concept of “usual care practice” for dysphagia is not supported. Utilization of research-supported assessment techniques and exercise-based approaches was also sparse. These data clearly highlight ongoing challenges to professional education and growth in the area of dysphagia management. HubMed – rehab

A curriculum focused on informed empathy improves attitudes toward persons with disabilities.

Perspect Med Educ. 2013 Mar 6;
Miller SR

Empathy is an important component of the provider-patient relationship. In the United States one in five persons has a disability. Persons with disabilities perceive gaps in health care providers’ understanding of their health care preferences and needs. The purpose of this study was to use valid and reliable assessment methods to investigate the association between empathy and attitudes toward persons with disabilities and advocacy. An educational module was developed to enhance health care students’ capacity for informed empathy. Pre- and post-assessment measures included the Attitude toward Disabled Persons scale (ATDP), the Attitudes toward Patient Advocacy Microsocial scale (AMIA) and the Interpersonal Reactivity Index (IRI). ATDP (t(94) = -5.95, p = .000) and AMIA (t(92) = -5.99, p = .000) scores increased significantly after the education module. Correlations between the pre- or post-module ATDP or AMIA scores and the IRI scores were not significant. Empathy in general may not be sufficient to ensure optimal attitudes toward persons with disabilities or advocacy in pre-health care professionals. However, a curriculum based on informed empathy and focused on the experiences of persons with disabilities can result in more positive attitudes toward and advocacy for people with disabilities. HubMed – rehab

The effect of unilateral superior laryngeal nerve lesion on swallowing threshold volume.

Laryngoscope. 2013 May 13;
Ding P, Campbell-Malone R, Holman SD, Lukasik SL, Thexton AJ, German RZ

OBJECTIVES/HYPOTHESIS: The superior laryngeal nerve (SLN) is the major sensory nerve for the upper larynx. Damage to this nerve impacts successful swallowing. The first aim of the study was to assess the effect of unilateral SLN lesion on the threshold volume sufficient to elicit swallowing in an intact pig model; this volume was defined radiographically as the maximum bolus area visible in lateral view. The second aim was to determine if a difference existed between ipsilateral and contralateral function as a result of unilateral sensory loss, measured as the radiologic density of fluid seen in the valleculae. Finally, we determined whether there was a relationship between the threshold volume and the occurrence of aspiration after a unilateral SLN lesion. STUDY DESIGN: Repeated measures animal study. METHODS: Four female infant pigs underwent unilateral SLN lesion surgery. The maximum vallecular bolus area in lateral view and the relative vallecular density on each side in the dorsoventral view were obtained from videofluoroscopic recordings in both the prelesion control and postlesion experimental states. RESULTS: In lateral view, the lesioned group had a larger maximum bolus area than the control group (P??.05). A bigger maximum bolus area did not predict aspiration in the lesioned group (P?>?.05). CONCLUSIONS: Unilateral SLN lesions increased the swallowing threshold volume symmetrically in right and left valleculae, but the increased threshold may not be the main mechanism for the occurrence of aspiration. Laryngoscope, 2013. HubMed – rehab

Cost of care according to disease-modifying therapy in Mexicans with relapsing-remitting multiple sclerosis.

Acta Neurol Belg. 2013 May 14;
Macías-Islas MA, Soria-Cedillo IF, Velazquez-Quintana M, Rivera VM, Baca-Muro VI, Lemus-Carmona EA, Chiquete E

Limited data exist on the costs of care of patients with multiple sclerosis (MS) in low- to middle-income nations. The purpose of this study was to describe the economic burden associated with care of Mexican patients with relapsing-remitting MS in a representative sample of the largest institution of the Mexican public healthcare system. We analysed individual data of 492 patients (67 % women) with relapsing-remitting MS registered from January 2009 to February 2011 at the Mexican Social Security Institute. Direct costs were measured about the use of diagnostic tests, disease-modifying therapies (DMTs), symptoms control, medical consultations, relapses, intensive care and rehabilitation. Four groups were defined according to DMT alternatives: (1) interferon beta (IFN?)-1a, 6 million units (MU); (2) IFN?-1a, 12MU; (3) IFN?-1b, 8MU; and (4) glatiramer acetate. All patients received DMTs for at least 1 year. The most frequently used DMT was glatiramer acetate (45.5 %), followed by IFN?-1a 12MU (22.6 %), IFN?-1b 8MU (20.7 %), and IFN?-1a 6MU (11.2 %). The mean cost of a specialised medical consultation was 74.90 (US $ 107.00). A single relapse had a mean total cost of 2,505.97 (US $ 3,579.96). No differences were found in annualised relapse rates and costs of relapses according to DMT. However, a significant difference was observed in total annual costs according to treatment groups (glatiramer acetate being the most expensive), mainly due to differences in unitary costs of alternatives. From the public institutional perspective, when equipotent DMTs are used in patients with comparable characteristics, the costs of DMTs largely determine the total expenses associated with care of patients with relapsing-remitting MS in a middle-income country. HubMed – rehab