The Clinical Swallowing Evaluation (CSE) is a critical part of dysphagia management. However, it is often misused and over interpreted. In this high-energy installment of Down the Hatch (The Swallowing Podcast) SLPs Rinki Varindani Desai and Beth Shah, along with Hosts Ianessa Humbert and Alicia Vose, discuss whether the CSE should really be considered a screening and if swallowing is actually being evaluated at all.

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com).

This installment is focused on the topic of weakness and fatigue. Have you ever decided that one of your dysphagic patients needs strength training? If so, can you define weakness or fatigue? In this episode, we discuss weakness and fatigue with Dr. Leo Ferreira, an associate professor in the department of Applied Physiology & Kinesiology at the University of Florida. He is a clinically trained physical therapist and scientist who studies muscle biology and aims to develop new therapies for skeletal muscle weakness in chronic diseases. Our aim in this podcast is to encourage clinicians who treat dysphagia to re-think whether their patients are truly weak, versus whether they have timing, range of motion, or even sensory abnormalities. Listen, consider, and enjoy!

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com). See more swallows here, including the squirt swallow, that is discussed in this episode: https://www.youtube.com/channel/UCq8_kb-4JkisYLtrHMQ8bnw/videos

Parkinson's Disease (PD) can lead to swallowing disorders (dysphagia). Swallowing disorders in PD can be serious because it can lead to aspiration pneumonia, which is one of the most common causes of death in PD. In response to a special request by the National Parkinson Foundation (www.parkinson.org), this installment of Down the Hatch (The Swallowing Podcast) focuses on swallowing impairments in PD. Special guest experts Karen Wheeler-Hegland, Ph.D., CCC-SLP and Emily Plowman, Ph.D., CCC-SLP discuss issues related to swallowing disorders in PD for patients, care-givers, speech-language pathologists, physicians, and the general public.

Down the Hatch (Swallowing Podcast) lucky number 13!
Dr. Catriona Steele, a prolific scientist and swallowing expert, launches the first episode in our series called EXPERT RANT on the following 3 topics:
1. Revisiting the Clinical Swallowing Evaluation from Down the Hatch 12: Screen versus Evaluation?
2. Do Penetration-Aspiration Scale scores of 4 and 6 actually exist?
3. Get more aggressive with your rehab!
Solutions: Clinicians and Researchers …. JOIN FORCES!
Enjoy (-:

Laryngeal vestibule closure (LVC)is one of the most complicated and critical swallowing events, but it remains poorly understood. In this episode of Down the Hatch (The Swallowing Podcast), we continue the Swallowing Physiology Series, with Ianessa and Alicia discussing the ins and outs of LVC and why it is often misunderstood and under-appreciated. By the end of the podcast, hopefully you will understand why listing poor or incomplete epiglottic inversion provides insufficient information about the cause of this type of LVC impairment.

“I don’t want to be too dramatic, but the NPO is almost like a death sentence … I really think that it should be the last recourse and not the beginning”. This one of many sincere opinions from an individual who has been living with a significant swallowing disorder. In this episode of Down the Hatch, the swallowing podcast, co-hosts Alicia Vose and Ianessa Humbert have a conversation with Jim, who suffered a brainstem stroke, leading to dysphagia. His very candid experience is the heart of why service delivery by Speech Language Pathologists to manage dysphagia does not just potentially impact life, but also LIVELIHOOD. Click to see a clip of this patients swallow: https://youtu.be/OpFjLLDbS-c

What is an expert? Do more years of experience guarantee a deepening of knowledge? Do scientists think differently than clinicians? In this episode of Down the Hatch (The Swallowing Podcast), hosts Alicia Vose and Ianessa Humbert discuss how to obtain knowledge, with an emphasis on swallowing and swallowing disorders. This episode was created in response to feedback from the Swallowing Physiology Series we recently completed, where listeners wanted to know "How do I become an expert in swallowing?" and, importantly, "How do I know who to trust as an 'expert' in swallowing?". Vose and Humbert differentiate Clinical thinking from Scientific thinking and make practical suggestions for how to obtain knowledge, ranging from self-study to academic degrees. How have you deepened your knowledge on the topic of swallowing and swallowing disorders?

Head and neck cancer can cause devastating swallowing problems, requiring a unique approach. This episode of Down the Hatch (The Swallowing Podcast) includes guest Heather Starmer, M.A., CCC-SLP who has extensive clinical and research expertise in dysphagia due to head and neck cancer. In addition to basics that make this population distinct, we dive into a few soap boxes including whether residue is "a thing"! Despite limited time, you will find this to be a very informative podcast about a very special type of dysphagia.
Link to her paper on Gabbapentin: https://www.ncbi.nlm.nih.gov/pubmed/24633355

So, what's the deal with e-stim? A question that is often asked. In this episode of Down the Hatch (the podcast about swallowing), doctoral student and SLP Alicia Vose and Assoc. Prof and mentor Ianessa Humbert re-unite after a brief hiatus to take up a controversial topic in dysphagia management - electrical stimulation. I think this topic is in keeping with the climate of 2017 in the United States of America, don't you?

Does more pharyngeal residue mean that there is reduced pharyngeal pressure? Do greater pharyngeal pressures occur when swallowing thicker boluses? Does the Mendelsohn Maneuver reduce UES pressures? Dr. Corinne Jones of the University of Wisconsin (Madison) joins Down the Hatch (The Swallowing Podcast) as our special guest. We discuss Dr. Jones' area of expertise in High Resolution Manometry (HRM) research, including pharyngeal and UES pressures during swallowing.

To address feeding and swallowing impairments in the pediatric population, one requires highly specialized knowledge. Still, pediatric dysphagia is extremely understudied and underfunded and SLP clinicians often learn on the job. In this episode, Dr. Emily Zimmerman, an expert in pediatric dysphagia, primes the Down the Hatch (Swallowing Podcast)listening audience as well as hosts Ianessa Humbert and Alicia Vose on how to approach pediatric dysphagia.

Recently, an overwhelming 92% of clinicians responded “NO” to the question: Did you feel prepared to assess and treat swallowing disorders upon graduation (Plowman & Humbert 2018). 45% of SLP survey respondents think that more dysphagia courses would improve competency (McCoy & Desai 2018). To help address this need, Down the Hatch (The Swallowing Podcast) has launched The Swallowing Physiology Series, where several oropharyngeal events that are important for swallowing will be spontaneously discussed by hosts Drs. Ianessa Humbert and Alicia Vose. Further, we will indicate whether each event can be assessed in clinical evaluations versus instrumental evaluations. Since podcasts are audio only, consider subscribing to the Swallowing Training and Education Portal for detailed visuals of these events (stepcommunity.com). Also, watch a video here on differentiating swallow delay from pre-mature spillage: https://www.youtube.com/watch?v=DXUHPiRVITc

Expiratory muscle strength training (EMST) is a device driven-therapy based in exercise physiology principles and used in dysphagia management. Although it is a non-swallowing treatment, it is known to have important utility in increasing the effectiveness of cough. Hosts Ianessa Humbert and Alicia Vose discuss the ins and outs of EMST with SLP and doctoral student Lauren Tabor.

The Coronavirus (COVID-19) pandemic has drastically changed health care practice around the world. Many medical speech language pathologists are uncertain about how and whether to continue managing patients with swallowing impairments (dysphagia), and if so... whom? In this episode of Down the Hatch, special guests with expertise in swallowing research and clinical practice discuss questions that center around whether SLPs are essential practitioners at this critical time.

Links to sources referenced can be found here:
https://pubmed.ncbi.nlm.nih.gov/25129577/ https://insights.ovid.com/clinical-pulmonary-medicine/cpulm/2018/09/000/aspiration-asp-sh-noun-ambiguous-term-used/4/00045413 https://pubmed.ncbi.nlm.nih.gov/9513300/ https://www.entnet.org/sites/default/files/uploads/covid-19_endosb_lettertoeditor_neurosurgery_update3.23.20.pdf https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy?fbclid=IwAR2T5mtY9cmBZHzrlC5pksT5yf2SzVyKFNjsOI-ErslyndZzV8qAPsb8XbI https://annals.org/aim/fullarticle/2763329/covid-19-risk-health-care-workers-case-report https://sacramento.cbslocal.com/2020/03/05/uc-davis-self-quarantine-test-negative/ https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers https://www.ncbi.nlm.nih.gov/pubmed/25807865 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459179/

CMS recommendations:
https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

AAOHNS's statement as of 3/26:
https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy?fbclid=IwAR1LGbGXaj66oBmwlEwuehHkYIF7odgm4GdhVRnvzBWr3IKWSGq50ngQ8qc

CDC on minimization of transmission within different settings:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html

Ventilation and PPE usage with aerosol transmission:
https://www.google.com/search?client=firefox-b-1-d&q=Factors+involved+in+the+aerosol+transmission+of+infection+and+control+of+ventilation+in+healthcare+premises

High-risk patient factors for severe illness from COVID-19:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html https://www.cisa.gov/sites/default/files/publications/CISA-Guidance-on-Essential-Critical-Infrastructure-Workers-1-20-508c.pdf?fbclid=IwAR1nrXpoPEIg40jdn4UH-k_TTeZK8-SAP4SyDtWc85xnicLOTjz1tN6O-4E

Back by popular demand, Down the Hatch’s Swallowing Physiology Series is now focused on neural control! In our Swallowing NEUROPhysiology Series, hosts Drs. Ianessa Humbert and Alicia Vose focus on concepts related to the central nervous system, not just because it controls swallowing, but also because it is among the most poorly understood and highly requested topics among those who aim to learn more about swallowing. In this installment, we move beyond the peripheral nervous system (cranial nerves) and introduce concepts that include cranial nerve nuclei and central pattern generators within the brainstem that are essential to swallowing.
Full links to papers:
https://www.ncbi.nlm.nih.gov/pubmed/11274347 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992653/ https://link.springer.com/article/10.1007/BF02407121

The field of Speech Language Pathology is 95% white female. As a result, efforts to increase diversity in this discipline have been ongoing, yet somewhat unsuccessful. It is possible that issues surrounding the whiteness of SLPs could be better explored with open conversations about this matter. Is it a problem? Would more diversity improve patient care or training the next generation? Guests Jessica Forbes, MS, CCC-SLP and Anu Subramanian, Ph.D., CCC-SLP join hosts Alicia Vose and Ianessa Humbert in raucous, candid, controversial, and sometimes explicit, banter about being a white, brown, or other SLP in the field of Speech Language Pathology.

Physicians play a critical role in dysphagia management, even though swallowing may not have been included in their medical training. This installment of Down the Hatch features a conversation with Dr. Michael Okun, Department Chair of Neurology and Co-Director of the Movement Disorders Center of the University of Florida. We discuss the lack of training across medical disciplines in dysphagia as well as suggestions for how swallowing clinicians and researchers can advocate for improvements in dysphagia management. Get up! Stand up!

The data are abysmal! In a recent publication, partly authored by Down the Hatch Hosts Alicia Vose and Ianessa Humbert, we reveal that SLP identification of swallowing impairments is poor to moderate. Why? Many could not differentiate disordered swallowing events from normal ones. In this installment with Special Guests Justine Allen and Michela Mir (both Doctoral Students and SLPs with clinical experience), we discuss this proverbial Ground Zero. Acceptance: This is the first STEP toward SLP competence in Dysphagia Management.