Angela Mansolillo – PESI – Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

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Angela Mansolillo – PESI – Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

What’s the safest diet? Is he aspirating? Can she swallow these pills? He hates the pureed food – what else can we do? She’s refusing the thick liquids! Is he going to get pneumonia? Does he need a feeding tube?

These are issues that we face every day in our work with children and adults with dysphagia. How do we keep our clients safe, while making sure they’re well hydrated and well nourished, and normalize eating as much as possible?

Sometimes, it’s about more than just swallowing.

This course will examine the inter-relationships between respiration, gastrointestinal function, and swallowing to allow clinicians to better identify the underlying causes of their client’s swallowing difficulties. We’ll look at specific respiratory and GI diagnoses and their impact on what, when, how much, and how safely our clients eat. Using clinical case studies, we’ll examine the evidence to provide you with the tools you need to perform a thorough assessment and implement a comprehensive treatment plan that takes into account all of the potential contributing factors. ​

Speaker

Angela Mansolillo, MA/CCC-SLP, BCS-S
Angela Mansolillo, MA/CCC-SLP, BCS-S, is a speech-language pathologist and Board-Recognized Specialist in Swallowing Disorders with over 21 years of experience. She is a senior speech-language pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she is involved in evaluation, treatment, and program planning for adults and children with dysphagia.

Ms. Mansolillo received her Bachelor of Arts degree in communication from Rhode Island College and earned her Master of Arts in speech-language pathology from the University of Connecticut.

Speaker Disclosures:
Financial: Angela Mansolillo has an employment relationship with Elms College and Cooley Dickinson Hospital. She is a consultant with Dysphagia Services and receives speaking honorarium from Education Resources, Inc., HomeCEUconnection.com, SpeechPathology.com, Medbridge, Respiratorytherapy.com, ContinuEd. Angela Mansolillo receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Angela Mansolillo is a member of ASHA.

Objectives

1. Use your understanding of the interrelationships between the respiratory and gastrointestinal systems to identify and treat the causes and not just the symptoms of dysphagia in your pediatric and adult clients.
2. Evaluate the impact of respiratory and gastrointestinal functions on swallowing systems in order to choose targeted interventions and increase your effectiveness in reducing aspiration risk.
3. Design effective treatment plans for clients with respiratory and GI disease processes including COPD, respiratory failure, and GERD.
4. Prepare your diagnostic tool box to include cough testing, water screenings, pulse oximetry, respiratory muscle strength testing, and other evidence-based tools.
5. Develop successful treatment plans by identifying reflux disease and its impact on swallowing function in your clients.
6. Design assessment strategies that allow you to identify those clients who are more likely or less likely to get sick as a result of aspiration.

Outline

RESPIRATORY SYSTEMS: Breathing/swallowing coordination

• Overview of systems – anatomy/physiology
• Breathing/Swallow coordination
• Coordination and aspiration
• Airway protective mechanisms
• Reflexive cough

GASTROESOPHAGEAL SYSTEMS: The impact on feeding and swallowing

• Esophageal function
• Digestive functions
• Reflux mechanisms
• When does GER become GERD?
• GERD signs and symptoms
• GERD and feeding/swallowing difficulties
• Esophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS: What’s the connection?

• Pressure, energy, and innervation
• Extra-esophageal reflux

ASPIRATION: How much is too much?

• Pulmonary Clearance Mechanisms
• Predictors of pneumonia in various populations

RESPIRATORY DISEASE PROCESSES: The impact on feeding/swallowing

• Pediatric:
  • Infant Respiratory Distress Syndrome (IRDS)
  • Bronchopulmonary Dysplasia (BPD)
  • Respiratory Synctial Virus (RSV)
  • Congenital Heart defects
• Adult:
  • Obstructive Sleep Apnea (OSA) and dysphagia
  • Congestive Heart Failure (CHF)
  • Obstructive Conditions
  • Restrictive Conditions

PNEUMONIAS: It’s not all aspiration

• Pneumonia vs Pneumonitis
• Community Acquired Pneumonia
• Healthcare Acquired Pneumonia
• Aspiration Pneumonia

AIRWAY MANAGEMENT: What’s the impact on swallowing?

• Non-invasive positive pressure ventilation
• High flow nasal cannula
• Intubation
• Tracheostomies

ASPIRATION ASSESSMENT: Clinical Assessment – Making the Most of your Bedside Eval

• Cognitive assessment
• Pitch elevation
• Serial swallows
• Oral mechanism
• Respiratory factors
• Cough
• Respiratory muscle strength
• 3 oz water tests
• Understanding lab values
• Pulse Oximetry

Instrumental assessment – Which type and when?

• Modified Barium Swallow studies
• Fiberoptic Endoscopic Evaluation of Swallowing

ASPIRATION MANAGEMENT: Diet modifications – Not such a benign intervention

• Implications of dietary changes
• Compliance issues
• Thick liquids – pros and cons
• Water protocols

Strategies and Exercises – What does the evidence tell us?

• Compensation
• Sensory interventions
• Principles of exercise physiology
• Lingual strengthening
• Pharyngeal strengthening
• Expiratory muscle strength training

REFLUX ASSESSMENT:

• What do these tests tell me?Upper GI studies
• Ph Monitoring
• Esophagoscopy
• Scintigraphy

REFLUX MANAGEMENT:

• What’s the dysphagia clinician to do?Lifestyle modifications
• Positioning
• Diet modifications
• Medications
• Effects of acid suppression
• Surgical interventions
• New directions in reflux management

Target Audience

• Speech-Language Pathologists
• Speech-Language Pathology Assistants
• Occupational Therapists
• Occupational Therapy Assistants
• Respiratory Therapists
• Nurses
• Nursing Assistants
• Restorative Nursing Staff
• Dietitians
• Dietary Managers
• Long-Term Care Professionals

Reviews

Michele D
“This was the best continuing education class I’ve ever taken – just amazing!! I want to take more from Ms. Mansolillo now!”

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