Treating Dysphagia in Schools: Making It Easy to Swallow If a child with dysphagia enters your caseload, will you know how to help that student? Enhance your knowledge with the basics. School Matters
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School Matters  |   February 01, 2015
Treating Dysphagia in Schools: Making It Easy to Swallow
Author Notes
  • Lisa Rai Mabry-Price, MS, CCC-SLP, is associate director for ASHA school services. lmabry-price@asha.org
    Lisa Rai Mabry-Price, MS, CCC-SLP, is associate director for ASHA school services. lmabry-price@asha.org×
Article Information
Swallowing, Dysphagia & Feeding Disorders / School-Based Settings / School Matters
School Matters   |   February 01, 2015
Treating Dysphagia in Schools: Making It Easy to Swallow
The ASHA Leader, February 2015, Vol. 20, 36-37. doi:10.1044/leader.SCM.20022015.36
The ASHA Leader, February 2015, Vol. 20, 36-37. doi:10.1044/leader.SCM.20022015.36
When it comes to treating children with feeding and swallowing disorders, there is just as much value in knowing what you don’t know as there is in having a strong clinical skill set and knowledge base to address the disorder. In addition, speech-language pathologists must also understand how the Individuals With Disabilities Education Act applies to these students.
IDEA considers a disorder “educationally relevant” if the disability interferes with the student’s ability to participate in and access the educational curriculum with same-age peers. Students must be safe while eating in school, and they must maintain adequate nutrition to fully access the educational curriculum. Therefore, it is appropriate and necessary to treat dysphagia in the school setting.
SLPs typically are the most qualified professional to address dysphagia in schools. According to ASHA’s 2014 Schools Survey, 13.9 percent of SLPs who responded provide dysphagia services in their school. Nonetheless, this low-incidence disorder has high impact, and even those SLPs who are competent in treating it may feel the need to sharpen their skills in this area. For others, dysphagia may not have been a major part of their preparation and training, so they need to further develop their knowledge and skills.
So what skills and knowledge do SLPs need to acquire or broaden to manage feeding and swallowing disorders effectively? ASHA’s 2002 “Knowledge and Skills Needed by Speech-Language Pathologists Providing Services to Individuals With Swallowing and/or Feeding Disorders” outlines nine areas of basic competency:
  • Normal and abnormal anatomy and physiology related to swallowing function.

  • Signs and symptoms of dysphagia.

  • Proper procedures for analyzing and integrating clinical and instrumental information into a formal diagnosis of swallowing and feeding disorders with appropriate written documentation.

  • Indications for, and procedures involved with, instrumental techniques used to assist in diagnosis and management.

  • Basic management issues, including how to determine candidacy for intervention, as well as how to implement compensations and habilitative/rehabilitative therapy techniques.

  • How to educate and counsel individuals with swallowing and/or feeding problems and their parents, care providers or other supporting persons.

  • Importance of quality of life issues as they relate to the student and the student’s family.

  • Ability to identify and use appropriate functional outcome measures.

  • Understanding of medical issues related to swallowing and feeding disorders

These broad basic competencies include specific knowledge in several areas.
Diet modification—Understanding the value and use of modified food and drink consistencies such as puree, mechanical soft, pudding-thick, nectar-thick, honey-thick and thin; and being able to educate others about diet modifications for safe swallow.
Accommodations—Allowing the student extra time to complete snacks and meals to maximize swallow safety, nutrition and hydration.
Positioning for safe swallow—Understanding the importance of body positioning for safe swallow. For example, if able, a child should be positioned with his or her head upright and stabilized, hips bent at 90 degrees in a sitting position with the feet stabilized. If the child is in a reclining wheelchair or bed, he or she should maintain an upright position for at least 30 minutes after meals to prevent reflux and subsequent aspiration.
Adaptive equipment—Knowing about the use of adaptive equipment to facilitate safe swallow and self-feeding, such as adaptive cups, spoons and plates, and use of dycem to hold plates, cups and utensils in place.
Emergency preparedness—Acquiring necessary emergency training when working with students who have feeding and swallowing disorders, including training in the use of the Heimlich maneuver and cardiopulmonary resuscitation in cases of airway obstruction.
Roles of dysphagia team members—Understanding the role of each team member, including the physical therapist, occupational therapist, nurse, dietician, cafeteria staff, social worker, teacher, paraprofessional, physician and parent, and valuing what each team member brings.
IDEA—Understanding the federal law and regulations, including the 13 disability categories, and knowing how feeding and swallowing disorders may affect educational performance.
Identifying the signs and symptoms—Recognizing signs and symptoms of aspiration and aspiration pneumonia, including a wet or gurgly voice and cough, spiking a fever, wet lung sounds, generalized malaise and refusal to eat or drink.
So where do you find programs to continue your professional development and growth? ASHA and other continuing education providers offer courses on managing dysphagia in the schools, evaluation of pediatric feeding and swallowing, and team development and treatment strategies for school-based dysphagia intervention.
ASHA members can also join Special Interest Group 13, Swallowing and Swallowing Disorders, to learn more from dysphagia experts. This group focuses on feeding and swallowing issues in all clinical settings and provides education and support through its Perspectives newsletter and e-mail list. Many SIG 13 members have received clinical specialty certification in swallowing.
In addition to professional development programs and affiliations, ASHA’s pediatric dysphagia practice portal offers information that can help broaden your knowledge. Finally, inquire within your state or local district. You may find dysphagia experts through your state association close to home who could serve as mentors or models to you along the way.
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February 2015
Volume 20, Issue 2