Value of Dysphagia Management Challenged: ASHA and Division 13 Respond to JAMDA Sometimes leadership comes with a cost: criticism and controversy. Speech-language pathologists’ key role in providing services and conducting research in swallowing disorders generated a harsh attack in a recent issue of the Journal of the American Medical Directors Association (JAMDA). ASHA and members of Special Interest Division 13, Swallowing and ... ASHA News
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ASHA News  |   November 01, 2008
Value of Dysphagia Management Challenged: ASHA and Division 13 Respond to JAMDA
Author Notes
  • Janet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, can be reached at jbrown@asha.org.
    Janet Brown, MA, CCC-SLP, director of health care services in speech-language pathology, can be reached at jbrown@asha.org.×
Article Information
Swallowing, Dysphagia & Feeding Disorders / ASHA News
ASHA News   |   November 01, 2008
Value of Dysphagia Management Challenged: ASHA and Division 13 Respond to JAMDA
The ASHA Leader, November 2008, Vol. 13, 3-29. doi:10.1044/leader.AN2.13162008.3
The ASHA Leader, November 2008, Vol. 13, 3-29. doi:10.1044/leader.AN2.13162008.3
Sometimes leadership comes with a cost: criticism and controversy. Speech-language pathologists’ key role in providing services and conducting research in swallowing disorders generated a harsh attack in a recent issue of the Journal of the American Medical Directors Association (JAMDA). ASHA and members of Special Interest Division 13, Swallowing and Swallowing Disorders, rallied to counter a sweeping disparagement of the value of dysphagia intervention and the training of SLPs.
In her featured article, clinical neuroscientist Irene Campbell-Taylor states, “there is no evidence to support the suggested need for such management [of swallowing impairment]” and that “the majority of SLPs and other allied health professionals engaged in the management of OPD [oropharyngeal dysphagia] are inadequately trained.”
In his editorial in the same issue, physician David Thomas acknowledges that Campbell-Taylor’s article “…is controversial and the opinions will not be necessarily acceptable to people on many sides. The Journal accepted this as a starting place for an ongoing dialogue.”
Division 13’s e-mail list was active immediately following the publication of the journal. ASHA’s leaders and Catriona Steele, Division 13 Steering Committee coordinator, agreed that ASHA President Kate Gottfred would respond to the attack and that a group of swallowing experts would respond to the selection and interpretation of evidence cited in Campbell-Taylor’s article.
Steele quickly organized a group of experts, some of whose work was cited and critiqued by Campbell-Taylor. The group included members of the Specialty Recognition Board on Swallowing as well as division affiliates employed by the Veterans Health Administration, whose efforts to streamline and standardize swallowing assessment were challenged in the article. In less than two weeks, led by Steele and Jim Coyle, a total of 14 authors (including Lori Davis, Caryn Easterling, Darlene Graner, Susan Langmore, Steven Leder, Maureen Lefton-Greif, Paula Leslie, Jeri Logemann, Linda Mackay, Bonnie Martin-Harris, Joe Murray, and Barbara Sonies) developed and submitted an article, “Oropharyngeal Dysphagia Assessment and Treatment Efficacy: Setting the Record Straight,” to JAMDA.
The journal has accepted Gottfred’s letter to the editor and the division’s article for publication in January 2009. Gottfred’s letter points out information on ASHA’s consumer Web site that was misrepresented in Campbell-Taylor’s article and cites examples of ASHA’s investment in the area of swallowing (e.g., policy documents, journals, special interest division, continuing education offerings), including ASHA’s “…fostering of responsible dialogue among its members for the sake of advancing the research and practice of dysphagia care.”
The article by the group of experts responds to Campbell-Taylor’s challenges about the value of videofluoroscopy, thickened liquids, aspiration prevention, and dysphagia intervention. The article takes issue with the “incomplete and one-sided” interpretation of the literature and provides a “complementary perspective” on these issues.
The controversy points up the role that SLPs have assumed in the area of dysphagia research and management over the past two decades. SLPs’ leadership in focusing attention on the importance of swallowing disorders and making significant contributions to the scientific literature has engaged the attention of medical directors and other health care professionals. The collaboration among ASHA and experts from Division 13, the Specialty Recognition Board in Swallowing, and the Veterans Health Administration helps to ensure that the debate about dysphagia research and practice is a two-sided dialogue.
Note: The Steele et al. article and Gottfred’s letter to the editor, scheduled to appear in the January 2009 JAMDA, cannot be released prior to publication. Go to the ASHA Web site for links to both.
References
Campbell-Taylor, I. (2008). Oropharyngeal dysphagia in long-term care: Misperceptions of treatment efficacy. Journal of the American Medical Directors Association, 9, 523–531. [Article] [PubMed]
Campbell-Taylor, I. (2008). Oropharyngeal dysphagia in long-term care: Misperceptions of treatment efficacy. Journal of the American Medical Directors Association, 9, 523–531. [Article] [PubMed]×
Thomas, D. R. (2008). Hard to swallow: Management of dysphagia in nursing home residents. Journal of the American Medical Directors Association, 9, 455–457. [Article] [PubMed]
Thomas, D. R. (2008). Hard to swallow: Management of dysphagia in nursing home residents. Journal of the American Medical Directors Association, 9, 455–457. [Article] [PubMed]×
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November 2008
Volume 13, Issue 16