Motor Learning: Swallow Neurophysiology Series by Down the Hatch - The Swallowing Podcast

Are there foundational principles that ALL SLPs should know about cranial nerve testing? Are we are checking off a list of nerves we've probed or are we tying behaviors we see back to function? What about relevance to the central nervous system? Dr. Kendrea Garand joins hosts Ianessa Humbert and Alicia Vose in a discussion about how to conduct and interpret cranial nerves among SLPs.

96.3% of Speech Language Pathologist self-identify as female. In this episode of Down the Hatch Podcast, we are joined by 4 male SLPs to discuss the female dominance of our profession. Our guests Ryan Bransky, Rick McAdoo, Dan Weinstein, and Anthony Avitabile engage in a deep, tangential discussion (trigger warning: strong language at times). But rest assured that our conversation eventually touches on many points that, at some point, you all may have considered. Does it matter that we are so heavily female dominated? Would patients be served better with more male SLPs? Would we earn more money, more respect with more male colleagues? Listen to our opinions and, please, share yours!

Sensation is largely overlooked in swallowing science and clinical practice. Why? It's difficult to test and to interpret! In this episode of Down the Hatch (The Swallowing Podcast), special guest Rachel Mulheren, Ph.D., discusses sensation as it relates to swallowing. How are sensation and perception different? How do we use cranial nerve sensory testing to make clinical decisions about swallowing behavior? Can we learn about sensation during videofluoroscopic studies? Although swallowing sensation is poorly understood, we attempt to address these questions and more in this discussion.

Do you decide which patients will have swallowing therapy or modified diets? Are you aware of your role in modifying Experience Dependent Plasticity as a clinician managing swallowing impairments? In this episode of Down the Hatch (Swallowing Podcast), co-hosts Ianessa Humbert and Alicia Vose continue the Swallowing Neurophysiology Series and discuss Experience Dependent Plasticity in dysphagia management with Dr. Phoebe Macrae. Access the full text manuscript about EDP in Dysphagia Management here (authors Macrae and Humbert 2013): https://link.springer.com/article/10.1007/s40141-013-0025-y

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 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

There were some issues with the original release of this eposide, so this is a re-release: Original description: It happens every time. A particular question is posed by one member of an audience of speech language pathologists who treat dysphagia. The question is cautious with a hint of frustration: How do I deal with inadequate modified barium swallow study reports from other speech language pathologists? In this Down the Hatch #9 (Swallowing Podcast), Alicia Vose and I discuss dysphagia documentation dilemmas for the evaluating clinicians who conduct modified barium swallow studies and write reports and for the treating clinicians who rely on the reports from evaluating clinicians to guide the treatment plan for patients in their care. SLP clinician experts Michele Singer and Nicole Roth weigh in to add immediate clinical relevance to this critical, and somewhat controversial, clinical topic.

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.

“I just listened to your DTH podcast with Jim. In my humble opinion I think this podcast should be required listening for every SLP student and every SLP everywhere who deals with dysphagia….” “To expose what has become a very comfortable lie in exchange for the integrity and power of the truth is likely the greatest kindness one human can offer to another… As a direct result, I will do better” “Hi I just listened to Jim share his story. My heart was broken…” “Honestly, this podcast really spoke to me and motivated me to push…” These are the sincere responses to the DO BETTER message that has been pushed in the Down the Hatch Swallowing Podcast and that has been emerging among SLPs in swallowing. In this episode, Ed Bice, Alicia and Ianessa Humbert continue discussing the system that influenced Jim’s experience in dysphagia management. It’s a wild, honest, passionate conversation. Recommendation: Listen with your adult beverage of choice!

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

“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?

In this last episode of The Swallowing Physiology Series, hosts Alicia Vose and Ianessa Humbert tackle both the pharynx and the upper esophageal sphincter (UES). This includes Down the Hatch Podcast (swallowing podcast)covers structure, function, and relevance to aspiration and residue for the pharynx and UES. We also discuss whether traditional exercises can really impact these structures as well as just plain old swallowing can... begging the questions: 1. Is swallowing the best treatment for swallowing? 2. What role do SLPs play in ensuring that patients get to practice swallowing with a wide range of bolus types?

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.

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

ASHA... What are you doing for your membership? For quality improvement of dysphagia management? This is a common question among ASHA members. In this installment of Down the Hatch (The Swallowing Podcast)Host Ianessa Humbert is joined by ASHA President hopeful Luis Riquelme PhD and colleague Ed Bice to discuss ASHA's role in maintaining clinical competence among speech language pathologists, especially those engaged in dysphagia management.

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

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).

Do you think we need more swallowing therapies? Do you hand out a standard list of therapy worksheets for many of your patients with swallowing problems? Have you ever thought "Tell me what to do!" when faced with making decisions about treating patients? In this installment of Down the Hatch (The Swallowing Podcast), Alicia and Ianessa discuss the dilemma facing many SLPs who treat dysphagia. Alicia and I suggest focusing on the process of deciding whether therapy is needed and/or which therapy should be recommended, and we suspect that very little time is spent on clinical decision-making (rather just the execution of therapy). This is a skill that SLPs should possess and is required to actually provide the correct individualized treatment, rather than simply providing the same list of swallowing therapies for all of individuals with dysphagia.