Dysphagia
This section highlights the ethical and patient-centered principles of dysphagia management, including advocacy, informed decision-making, and culturally responsive care. It also explores my clinical experiences across the lifespan, from school-based and skilled nursing settings to specialized pediatric and NICU interventions, covering assessment, treatment planning, discharge, and ongoing research.
" Advocacy and ethics is a major role in speech-language pathology. From recognizing the importance of instrumental imaging (e.i., MBSS, FEES) to respecting a patient’s desire to avoid a PEG tube. Advocacy goes beyond clinical decision-making, it involves educating the care team, and respecting the patient's autonomy in decision making."
~ Alexa Noseworthy ~
" As a future therapist, I have an ethical obligation to respect patient autonomy while also upholding beneficence and nonmaleficence. My motto is to provide education, collaboration, and skilled intervention that empowers patients to make informed decisions about their own care. "
5. Equity and Ethical Documentation in Dysphagia Services
Advocacy further involves addressing healthcare disparities by supporting access to instrumental imaging, therapy services, and appropriate follow-up regardless of socioeconomic status.
4. Interprofessional Collaboration in Dysphagia Management
Ethical advocacy includes collaborating with the interprofessional team, such as respiratory therapists, physicians, dietitians, nurses, physical therapists, and occupational therapists. Effective communication among team members helps ensure that swallowing management plans reflect both clinical safety and the patient’s personal goals.
3. Culturally Responsive Dysphagia Care
Advocacy also involves providing culturally responsive care. Food often carries deep social, cultural, and emotional meaning, and dysphagia recommendations must consider these factors while supporting safe and meaningful participation in meals.
2. Respecting Patient Autonomy
Reducing aspiration risk is an valuable and significant clinical goal. However, strict diets, or PEG tubes may not always align with a patient’s personal wishes. Therefore, ethical dysphagia management acknowledges and supports individual choices that reflect a patient’s goals, values, and quality-of-life considerations.
1. Informed and Documented Decision-Making
Patients and caregivers should receive explanations of risks, benefits, and alternative management strategies in a language they can understand. Equally important is thorough documentation to ensure that a patient's preferences and informed decisions are accurately recorded in the medical record.
Advocating for Patients with Dysphagia
"Advocacy involves respecting personal values, cultural identity, and quality of life. Effective advocacy means ensuring that patients are informed, heard, and supported throughout their care."
Ongoing Research:
Feeding Disorders
This study examined the types of words used by caregivers and children during a short meal. Here, the word types we examined were only those that reflect food and the eating context. Specifically, we coded word types that reflected sensory properties (e.g., visual, auditory, tactile, gustatory, interoception), the labeling of objects and actions (e.g., eat, apple, fork), and those meant for behavioral regulation (e.g., come on now).
The current study then explored how caregivers describe food, and the relationship with the child’s use of words and the textures they eat. We were interested in this question because little is known about what influences children’s food choices (McKinley, et al. 2005) and a component of treatment for children with pediatric feeding disorder (PFD; Goday, Huh, Silverman, Likens, Dodrill et al., 2019) is describing food properties (e.g., wet, crunchy). The intention is to help the child become more comfortable with new foods and to problem solve aversions related to the sensory characteristics of food
Discharge
Patient Expired; Hospitalized;
completed; stable; etc.
I summarized patient care through detailed documentation, monitored progress toward, and established goals. I provided thorough caregiver education, conducted follow-up observations to ensure carryover and safety. I also determined when a patient maintained stability and was appropriate for discharge from skilled services. Additionally, I closely monitor and report changes in patient status, including signs of decline that may warrant medical referral or hospitalization.
Treatment Plans
Compensatory Strategies; Adaptive Feeding Equipment;
Strengthening Exercises; Endurance Training; & Building PO Tolerance
Experience, trialing adaptive feeding equipment across the lifespan, including Provale cups, straw cups, 360 cups, and weighted cups, to support safer and more efficient feeding. I have trained patients in swallowing exercises such as the effortful swallow, chin tuck, Masako maneuver, and principles from IPOI therapy and bolus driven therapy, emphasizing functional theoretical principles of motor learning and neuroplasticity.
Additionally, I have educated patients and caregivers on compensatory strategies, including maintaining a 90-degree upright posture, taking small bites/sips, alternating liquids/solids, pacing intake, double swallows, supraglottic swallow, minimizing distractions during meals, visual feeding steps, and implementing appropriate diet texture modifications to enhance safety and independence. All while monitoring vitals, and communicating with inter professional departments to ensure carryover
Evaluations
Modified Barium Swallow Study (MBSS); Fiberoptic Endoscopic Evaluation of Swallowing (FEES);
Oral Mechanism Exam (OME), Functional Oral Intake Scale (FOIS)
Beginning with thorough case history, medical chart review, and caregivers interview. I have shared my professional role, performed screenings, and asked individualized questions. Leading to recommending diet levels across the IDDSI framework, including determining when a patient is appropriate for modified textures or when NPO status is necessary. I have observed and participated in Modified Barium Swallow Studies (MBSS) with completed training in MBSImP to assess swallow physiology and impairment patterns. I have foundational training in FEES, including understanding anatomy, identifying secretion management, and recognizing aspiration events. In addition, I have assessed vocal quality, cough strength, and secretion management to evaluate airway protection. Throughout evaluations, I diligently monitored vital signs and patient facial expressions to assess tolerance and overall comfort. I incorporated dynamic assessment during bolus trials, utilizing compensatory strategies and posture modifications to determine the safest and least restrictive diet recommendations. All while consistently considering the patient’s and caregivers’ goals to promote autonomy, functional independence, and quality of life.
Case Study
This case study examines the clinical evaluation of Mark, a patient presenting with symptoms of suspected dysphagia following a neurological event. During observation, Mark demonstrated difficulty chewing, coughing after swallowing, and reduced oral control, particularly when consuming thin liquids.
A clinical swallowing evaluation indicated possible aspiration risk, with improved tolerance when consuming thicker consistencies. Based on these findings, instrumental assessment using FEES was recommended to further evaluate swallowing safety and guide treatment planning.
This case highlights the importance of careful observation, clinical assessment, and instrumental evaluation in identifying dysphagia and developing appropriate management strategies to support safe swallowing, nutrition, and overall patient quality of life.
Summary
I have observed, received training in, and provided dysphagia assessment and intervention across the lifespan in a variety of clinical settings, including school-based services, private practice, and skilled nursing facilities.
Additionally, my training includes specialized experience in NICU stimulation and early feeding development. My university offered an advanced course in Pediatric Dysphagia and Procedures in Early Intervention, which provided in-depth instruction on human gestation and early childhood feeding development. The course also emphasized compensatory feeding strategies, including rate modification and the use of adaptive feeding equipment commonly utilized in NICU settings.
As part of this training, we participated in hands-on simulation experiences where we learned how to properly hold, position, dress, and feed medically fragile NICU infants connected to vital sign monitors. These simulations exposed us to real-time clinical scenarios, including episodes of oxygen desaturation, allowing us to practice recognizing signs of physiological instability and responding appropriately to ensure infant safety during feeding.
