Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) is approved by the United States Food and Drug Administration (FDA) to assess quantitatively laryngopharyngeal sensory perception related to deglutition. Sensory discrimination testing during FEESST is conducted via delivered air pulses to the laryngopharyngeal musculature infiltrated by the internal branch of the superior laryngeal nerve (ISLN). Jafari, Prince, Kim, and Paydarfar (2003) implied that the afferent nerve transmission from the ISLN was essential for a functional pharyngeal swallow, specifically in supplying information to primary efferent neural functions that control adduction of the laryngeal musculature during the pharyngeal phase of the swallow. Their research proposed that ISLN damage was a major factor in the development of dysphagia and aspiration.
During the FEESST procedure protocol, as described in Aviv and Murray (2005), a flexible endoscope is passed transnasally, along the floor of the nose, past the velopharyngeal port and into the hypopharynx. Sensory discrimination thresholds during FEESST are obtained bilaterally by endoscopically providing air pulse stimuli directly anterior to the arytenoid cartilage at the juncture of the aryepiglottic fold because this mucosa in the laryngopharynx is innervated by the ISLN. The stimulus is designed to trigger a laryngeal adductor reflex (LAR) via direct stimulation of the ISLN (Aviv et al., 1993). Ludlow, Van Pelt, and Koda (1992) found that stimulation of this mucosa elicited the LAR, which was an involuntary, concise closure of the true vocal cords. Aviv et al. (1999) found that this airway defense LAR was maintained by brainstem function. Once the air-pulse testing is done, the patient is then fed food and liquid consistencies mixed with green or
blue food coloring for contrast while the pharyngeal phase of the swallow is assessed evaluating food, liquid, and secretions.
FEESST assessments are performed with patients who demonstrate dysphagia, a difficulty in swallowing, as defined by Logemann (1998). Clinical experience has shown that the presence of dysphagia might place the patient at risk for tracheal aspiration. As described by Marik and Kaplan (2003), the event of tracheal aspiration occurs when a bolus, particulate matter, or patient secretions enter the trachea. Research has shown that further airway entry into the lungs because of tracheal aspiration can become a catalyst for infection and pneumonia (Kalra, Ramsey, & Smithard, 2003). FEESST was designed to obtain data that is more objective regarding laryngopharyngeal sensation, when compared to the clinical bedside swallow evaluation, which is a more subjective evaluation.
Clinical practice has shown that instrumental assessment is especially important in those patients who have silent penetration when the bolus enters the larynx at or above the level of the true vocal cords without a sensory clearing response. As discovered by Logemann (1998), the same importance for instrumental assessment holds true for the identification of silent aspiration, when the bolus enters the trachea without a sensory clearing response. Aviv et al. (1996) suggested that the importance of sensory discrimination testing in these patients might be significant because decreased sensation in the laryngopharynx could contribute to dysphagia and aspiration. Sensory loss in the laryngopharynx might be a catalyst in dysphagia and aspiration, presuming that, if the patient did not sense a bolus or secretions within the laryngopharynx, regular upper airway shielding reflexes might be deficient. Research has shown that patients with more severe sensory
loss in the throat with FEESST have shown a higher frequency and occurrence of silent aspiration into the trachea, suggesting that there is some association between the sensory nerve for the laryngopharynx (ISLN) and the sensory nerve for the trachea (recurrent laryngeal nerve RLN), which are both branches of cranial nerve X, the vagus nerve (Blicker, 2008).
Written by Dr Eric Blicker MA CCC-SLP.D BRS-S
Eric's ASHA approved CE Provider website can be found here: WWW.CEUALLIEDHEALTH.COM
Nothing makes me happier than to open up my email and see an email from a fellow colleague, student, or husband or wife trying to help each other or their child, and thanking me for my easy to read website. Putting out this hard to understand information in the simplistic of terms. Being as unbiased as I can (in some cases) and helpful in most. I want to continue to bring all of this to you, my readers, but with a question or two that I'd like you to respond to;
1. What do you like/dislike most on my website?
2. what is most helpful to you as whomever you are as a visitor? I prefer that you answer below in the comment box so everyone can see and a conversation could start. But if you don't feel comfortable and have something to say, feel free to email me at email@example.com
When I decided to take on this blog, I decided it was about providing information. But as it grew, it became bigger than I ever dreamed. Now I feel obligated to provide everyone with information as such as the follwoing.Is this Obamacare or just a conicidence? I find myself asking my question quite often. I'm I guess what you call a quiet political. I care, but I don't get involved. Being not only a healthcare provider but also a patient, I'm suddently seeing quite a bit of changes, and changes I don't like.POLST, MOST,
A Physician Orders for Life Sustaining Treatment (POLST) form is a document created by you and your doctor that informs emergency care providers what kinds of treatments you want (and don't want) in a medical emergency. POLST forms are like Do Not Resuscitate (DNR) orders in that they 1) must be signed by a doctor and, 2) instruct emergency medical whether to administer cardiopulmonary resuscitation (CPR). However, POLST forms cover many additional types of medical interventions, such as intubation, antibiotic use, and feeding tubes.
POLST forms are available in almost half of the states in the U.S. and they go by various names – MOLST, POST, COLST, TPOPP, LaPOST, etc. Learn more about the POLST form in your state in the articles below.
One example of a problem with a POLST from a reader would be; an ambulance is called to your home, no one is there to tell them of your medical directives for your mother. She has a DNR to which they are unawar. Without a POLST, they will initiate life saving measures. With a POLST, they won’t.This reeader informer me that she has had her mother keep hers posted on her refrigerator as well as herself and all her loved ones. To find out if it's currently in your state click here:http://www.nolo.com/legal-encyclopedia/physicians-orders-life-sustaining-treatment
Everyone should take a look at this. Unfortunately this kind of behavior occurrs on a nearly regular basis in SNFs & LTCs. No one should have to go through or even watch this subhuman conduct. I assure you, I haven't personally witnessed this kind of disgust or any evidence that it may have it occurred. I also know a lot A LOT of therapists who say the same thing. For the most part your loved ones are in good hands.However, there are no excuses, if you suspect one little thing is off, you talk to management. If it keeps happening, you get your loved one into another facility if you have to. Please click on the link below, read the article, and watch the video. If you find any of the information presented in the article familiar, either bring it to your management's attention (by-passing the nursing staff), or feel free to contact me & I'd be happy to assist if I can. http://m.bbc.co.uk/news/health-24958181
One of the many questions I often get asked is if I can provide templates of in patient or out patient Evals, SOAPS and/or progress notes for work in SNF's, Long Term Care Facilities, Rehabs and/or acute/sub acute care.
My reply is always the same. I wish I could. Besides providing the basic framework, there really isn't much of a template. Learning how to write medically just takes practice. Learning medical and clinical language as well as writing succinct and with abbreviations is a skill. Therefore, if you are looking to improve your clinical writing skills, I will assist you if you need it.
I often get approached by clinicians' looking to make a change in their career whether it's been 3 or 15 years, or if this is your first year or if your still a student.
I can help you get to where your comfortable. You are in the drivers seat. I will supply you with all the options available, you get to choose what, how much, and how often you want to work. That is what sets the price. And along the way, you will receive some (ok, alot) SLP treats from me, just ask some of my former students!
This includes writing Hospital SOAPS, SNF SOAPS, Bedside Assessments, Outpatient Dysphagia or Aphasia Evals, etc., Progress Notes for Adults or Children, Evaluations for Children and/or Adults.
If this is something you are interested in, email me at firstname.lastname@example.org.
Price is on a sliding scale. Inquire within.
I know we all just received the following email, but I think it should be given the recognition it deserves. This year ASHA has proved to be (excuse my language but) kicking BUTT to help it's certified members!!
They are at not only keeping up with the times by developing the ASHA app (and well I might add) but now they have gone and provided us with a discount program for ASHA members. We've had few discounts before, however they were not mainstream or useful to many of it's members.
The section of the website up and running already contains a lot of useful tools and discounts to assist in making business life and pleasure life easier.
The most important content added emphasizes the vital issue of health. Working as health providers, it's a well known fact that our decision to accept a job in certain environments dertermines whether or not we will or will not receive Health Insurance. Let me say that again, as Health Providers, we often take jobs that do not provide us with Health Insurance.
ASHA is now taking one very important step in the right direction and providing ASHA members with a Prescription discount program of 75% off of the your medications. Including generics.
The programs described above are extremely similar to freelancers union and I sure have been waiting for something like this to come around for a long time.
GO #ASHA!!!! KEEP IT UP!!!
Next up, let's see if you can provide ASHA members a group member Health Insurance Plan(s)?????!!! :)
Whether you are a practice owner who hires therapists, a therapist hired by a private practice, a home care agency, or hospital, or a therapist who holds themselves out to the public as an independent contractor, understanding what these classifications really mean is vital and has important ramifications for both parties. Let's take this issue out of the gray matter and separate fact from fiction.
This topic will be presented in detail from all perspectives as far as therapists are concerned, and from the vantage point of the Internal Revenue Service and the Labor Department, regardless of what state you live in.
Join in and:
1) Understand the specific criteria used to determine whether a therapist should be deemed an employee or an independent contractor.
2) Understand the rule of “Substance over Form “ application – why the substance of what a therapist does is far more important than the contract they sign!
3) Find out the specifics of what you can do to protect yourself if:
a. you want to classify a therapist as an IC
b. you want to classify some therapists as employees and some as ICs
4) Find out how to “clean” up your worker classifications before an audit
5) Find out what to do if you think you are being misclassified
6) Must have clauses in contracts!!!!
There will be an opportunity to ask questions live during the webinar. If you can’t attend on the 7th, don’t worry- you will be able to access the recorded webinar anytime 24/7/365!
Webinar includes a handout, copy of the powerpoint, and a copy of the worksheet - 10 steps to become an Independent Contractor.
* If 3 or more therapists from the same facility register for the webinar, you will receive 10% back on each registration fee.
Questions - please email Iris at email@example.com or call 845.430.7749
EARLY RATE REGISTRATION: $70 - includes all material and 24/7/365 access to recorded webinar after Nov 7th. Rate increases to $85 October 16th
to register: www.nytherapyguide.com- click on webinars
Take a look at what I was just astounded to receive below. At first I noticed that it is from the the UK, nothing against them, I'm half Brit! However, I do believe other countries other than the US been heavily involved in either trying to help our autistic children with good intentions tho without any evidence that I know of, wanting to teach our SLPs &/or teachers grammar courses when they themselves don't even know the correct definition, just trying to monetize on its behalf.- bc what I'm going to show you can't be good for any child nonethelss a child on the spectrum.
e-mail the company directly firstname.lastname@example.org and share your thoughts today!
Presented by the Connecticut Branch of the International Dyslexia Association, the astounding author of Overcoming Dyslexia Dr. Sally Shawitz is hosting:
A Family Literacy Forum on
Saturday, November 9, 2013 8:00 AM - 1:00 PM
185 Main Street, New Britain,
Featuring Keynote Speaker, Dr. Sally Shaywitz, distinguished Professor and Co-Director of the Yale Center for Dyslexia and Creativity, and author of the widely acclaimed national best-seller, Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level.
Don’t miss this important family event highlighting the work of Dr. Sally Shaywitz -- including a viewing of her HBO movie The Big Picture: Rethinking Dyslexia -- also featuring a panel discussion on dyslexia in Connecticut, and a resource fair.
Additionally, education graduate students will be conducting free literacy screenings throughout the morning.
My personal opinion is that Overcoming Dyslexia is the best text for students dealing with & learning about Dyslexia. The HBO documentary was moving on and should be mandatory in low level functioning/graduating schools.
Click below to register
Click below for event summary
Langmore Foundation FEES Course: A Procedure for Evaluating Oropharyngeal Dysphagia
Download the attached file for the full application
This program provides an opportunity to develop an understanding of the FEES procedure and gain experience with interpreting FEES for the evaluation and management of oropharyngeal dysphagia.
The course is taught by Susan Langmore, PhD. BRS-S, who developed the FEES procedure in 1988. She has used it with all types of adult patients, including ICU, inpatients, outpatients and nursing home patients. She is experienced in working with virtually all types of dysphagia. Dr. Langmore is a full time clinician who also conducts extensive research and has given presentations on dysphagia around the world. Dr. Langmore will be assisted by other speech pathologists and otolaryngologists in the department who use this procedure.
The participant will attain a minimal level of competence in performing the protocol, interpreting the results of FEES examinations and using endoscopy to guide therapy for patients with dysphagia. With a guarantee of passing the endoscope at least 5 times, he/she will become familiar with handling the endoscope passing it into the hypopharynx, and manipulating the scope within and around the larynx to attain an optimal view.
On conclusion of the program, the participants will be able to:
1. Understand what can be visualized and understood about normal and abnormal swallowing from an endoscopic image.
2. Know clinical indications and risks for performing FEESR.
3. Follow a protocol for administering a FEESR exam.
4. Identify key structures, identify and interpret findings, and apply appropriate therapeutic interventions during the performance of a FEESR exam.
5. Implement and adapt the FEESR protocol for different patient populations and settings.
6. Know how to use endoscopy to manage patients with dysphagia.
7. Learn how to implement FEESR into their employment setting.
8. Have an introductory level of skill in passing the endoscope safely and know how to position the scope to get an ideal view during the FEESR examination.
Registration for the Langmore Foundation FEES Course
Yes, I want to attend the Foundation FEES Course
I am registering for the course on the following dates (choose one)
( ) October 25 & 26, 2013 ( ) January 24& 25, 2014
Affiliation/ Department ____________________________________________________________
City/ State/ Zip code _________________________________________________________________
Home Address: _____________________________________________________________________
Phone ______________________________________ Fax _________________________________
(Communication with the participant will be via email)
Please make check payable to “BUMC Otolaryngology Speech & Swallowing” for $550.00
Also, if more than one attendee comes to the same course the rates are as follows:
2 Attendees $475.00 each
3 Attendees $450.00 each
4 or more Attendees $400.00 each
Send the Check (sorry no credit cards or invoices) and this registration form to:
*** One Day Advanced Course $300.00 each
This program is offered for 1.35 CEU’S (Intermediate level; Professional area)Marguerite Belmonte
Boston Medical Center
FGH Building, 820 Harrison Avenue
Boston, MA 02118
For more info, Contact- Marguerite Belmonte
Boston Medical Center
FGH Building, 820 Harrison Avenue
Boston, MA 02118
Transportation to Boston
Logan airport is 5 and 1/4 miles from the medical center
The Metropolitan Transit Authority has trains/buses to/from the airport and the city. A taxi will cost approximately $35.00
There are two hotels very close to the medical center. Please book your hotel early as they sometimes do not have available rooms.
Hampton Inn & Suites Boston Cross Town Center
· Phone: 617-445-6400
· Ask for Boston University Medical Center Rate
· This hotel is walking distance to the medical center
Marriott Courtyard in South Boston
· Phone: 617-436-8200
· They have a shuttle service to the Boston Medical Center
If you are driving to the Boston Medical Center Campus parking is available at garages located at 710 Albany Street, Boston MA, 02118.
This registration form (as a downloadable form at the top of this post) should be filled in and returned with your check.