Dysphagia Treatment Techniques/Strategies
**For Clinicians' Use
Dysphagia Treatment is decided upon once a diagnosis is confirmed. The clinician will choose a treatment program, based on the etiology and mental and physical capacity. They should discuss the treatment protocol with the patient; how it will help them specifically/anatomically, etc. and present all treatment options possibly for their swallowing problem.
Compensatory Strategies
-Diet Modifications based on what the patient can manage safely.
- Thin/Thick Liquids
- Thin/Thick puree food
- Regular diet
- Chopped/Mechanical soft diet
- Alternative texture/temperature
- Tube Feedings
- Alternate tube feedings with and without PO intake
-Consider environmental/stress factors.
- When/where/how the pt is eating/being fed
- Consider pt's position during meals
- Most importantly, consider pt's etiology and how it may be effecting PO intake
- Thin/Thick Liquids
- Thin/Thick puree food
- Regular diet
- Chopped/Mechanical soft diet
- Alternative texture/temperature
- Tube Feedings
- Alternate tube feedings with and without PO intake
-Consider environmental/stress factors.
- When/where/how the pt is eating/being fed
- Consider pt's position during meals
- Most importantly, consider pt's etiology and how it may be effecting PO intake
Thin Liquids Handout for Patient
| thinliquids_forpt.pdf |
Postural Changes
Specific postures are used to compensate for particular types of dysphagia by changing the way that the food moves through the pharynx. It is a good idea to have the patient try using these postures during the VFFS/MBS; this way you can get an idea of how well or what will really work or not work for that patient.
-Head Tilt - Move the head to better side, bolus is redirected through oral cavity and oral bolus transport is improved.
- Head Rotation - twist head to weaker side, so weaker side is closed off and bolus travels to stronger side. Avoids pocketing as well. When compared with a neutral head position, rotating the head to the left or right increased pharyngeal contraction pressure at the level of the valleculae and pyriform sinuses on the side of rotation, decreased UES resting pressure on the side opposite rotation, increased duration from peak pharyngeal pressure in the pyriform sinuses to the end of UES relaxation, and increased UES anterior-posterior opening diameter
- Chin Tuck - Put chin down to move bolus anterior. It prevents premature spillage and widens the valleculae so spillage hesitates there giving more time for VF's to close thereby reducing the risk of aspiration.
-Side Lying -The existing rational for use of the side-lying technique is that lying down will hold residual bolus material to the pharyngeal walls instead of allowing it to drop into the airway, which may more readily occur as a result of gravity in an upright position [4]. Logemann recommends the use of side lying when pharyngeal contraction is reduced such that residue is observed throughout the pharynx [4]. The side-lying posture was not included in any of the studies reviewed on LDRR on healthy swallowing; therefore, the physiological basis of this posture bears no support from exploratory research.
-Head Tilt - Move the head to better side, bolus is redirected through oral cavity and oral bolus transport is improved.
- Head Rotation - twist head to weaker side, so weaker side is closed off and bolus travels to stronger side. Avoids pocketing as well. When compared with a neutral head position, rotating the head to the left or right increased pharyngeal contraction pressure at the level of the valleculae and pyriform sinuses on the side of rotation, decreased UES resting pressure on the side opposite rotation, increased duration from peak pharyngeal pressure in the pyriform sinuses to the end of UES relaxation, and increased UES anterior-posterior opening diameter
- Chin Tuck - Put chin down to move bolus anterior. It prevents premature spillage and widens the valleculae so spillage hesitates there giving more time for VF's to close thereby reducing the risk of aspiration.
-Side Lying -The existing rational for use of the side-lying technique is that lying down will hold residual bolus material to the pharyngeal walls instead of allowing it to drop into the airway, which may more readily occur as a result of gravity in an upright position [4]. Logemann recommends the use of side lying when pharyngeal contraction is reduced such that residue is observed throughout the pharynx [4]. The side-lying posture was not included in any of the studies reviewed on LDRR on healthy swallowing; therefore, the physiological basis of this posture bears no support from exploratory research.
| pttypepostural.png |
Therapeutic Dysphagia Strategies
Therapeutic techniques are most often used with patients who have had brain stem lesions and so have severe dysphagia but still have good cognitive ability and can therefore follow the complex directives involved in completing the strategies.
Such strategies are:
Stimulation
Stimulation techniques involve the following:
- Thermal Stimulation - Used if there is a delayed swallow to increase sensitivity.
How to do Thermal Stimulation - Laryngeal Mirror must be very cold, sitting in ice for a long time before seeing pt. Put laryngeal mirror in the ice, Stroke the area around pt's faucial pillars /arches, base of tongue, and margin of velum. Strokes should be quick, back and forth motions. When finished with each rep, pt should swallow some bolus/liquid. Eventually this will wear off, and it doesn't work for every pt. Usually lasts for 4 - 5 swallows. Adjustments to consider while doing thermal stim, is adding "sour" into the mix. Remembering sensory stimulation as well. Adding sensory stim to the thermal stim in one. This can be done in several ways. I've done it via adding lemon aide powder directly to the ice, mixing it in the apple-sauce used as the bolus. I've also used "sweet" as a sensory stim, adding sugar to the apple sauce. The components here are "cold" and "sensory"
Motoric & Coordination
Exercises can be done to improve the range of motion (ROM) of the lips, tongue, and jaw, to improve coordination, to improve vocal fold adduction, laryngeal elevation, or tongue base retraction.
- Resistance Exercises - involve pushing against tongue depressor or spoon to create "resistance"
- Falsetto Exercises - used to increase laryngeal elevation. Involve repetitive /i/ or /ng/.
Laryngeal Elevation Exercises
- Pitch Glides - also used to increase laryngeal elevation. Open mouth with pitch variability in isolation from comfortable to high pitch or to low pitchSing “ee” starting in a low tone and then slowly raise your tone to your highest pitch. Hold pitch for 10 to 20 seconds.
␣ Repeat this exercise five times.
- Affirmative Pitch range - say /mhma/ increasing pitch at the end
Such strategies are:
Stimulation
Stimulation techniques involve the following:
- Thermal Stimulation - Used if there is a delayed swallow to increase sensitivity.
How to do Thermal Stimulation - Laryngeal Mirror must be very cold, sitting in ice for a long time before seeing pt. Put laryngeal mirror in the ice, Stroke the area around pt's faucial pillars /arches, base of tongue, and margin of velum. Strokes should be quick, back and forth motions. When finished with each rep, pt should swallow some bolus/liquid. Eventually this will wear off, and it doesn't work for every pt. Usually lasts for 4 - 5 swallows. Adjustments to consider while doing thermal stim, is adding "sour" into the mix. Remembering sensory stimulation as well. Adding sensory stim to the thermal stim in one. This can be done in several ways. I've done it via adding lemon aide powder directly to the ice, mixing it in the apple-sauce used as the bolus. I've also used "sweet" as a sensory stim, adding sugar to the apple sauce. The components here are "cold" and "sensory"
Motoric & Coordination
Exercises can be done to improve the range of motion (ROM) of the lips, tongue, and jaw, to improve coordination, to improve vocal fold adduction, laryngeal elevation, or tongue base retraction.
- Resistance Exercises - involve pushing against tongue depressor or spoon to create "resistance"
- Falsetto Exercises - used to increase laryngeal elevation. Involve repetitive /i/ or /ng/.
Laryngeal Elevation Exercises
- Pitch Glides - also used to increase laryngeal elevation. Open mouth with pitch variability in isolation from comfortable to high pitch or to low pitchSing “ee” starting in a low tone and then slowly raise your tone to your highest pitch. Hold pitch for 10 to 20 seconds.
␣ Repeat this exercise five times.
- Affirmative Pitch range - say /mhma/ increasing pitch at the end
Dysphagia Treatment with Rationale
For Purchase is a two page document I never leave my house without! It's my lifesaver. I created this while in graduate school and have since kept it updated. It is a quick cheat sheet which itemizes each Oral Pharyngeal Dysphagia Diagnosis and possible Therapy Strategies to attempt along with the rationales of why they would work. It should be noted that this is simply a "guide" and not meant to be used as a one fits all. It is always necessary to consider other factors which may change your treatment program (i.e, etiology, patient awareness & ability, etc.). For only $6.99 you can purchase this wonderful cheat sheet/guide to dysphagia treatment. To me, it is a lifesaver! As well, to many of my colleagues! To purchase: click on the Paypal button below and don't forget to add your email address so the document can be emailed to you! Should you have any questions, please feel free to email me at amyreinsteinslp@gmail.com
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase. All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
UPDATED Dysphagia Treatment II
The difference between this document for purchase and the one above, is that the Dysphagia Treatment is meant as a simple treatment cheat sheet to be carried around the hospital or SNF so you can quickly confirm your strategies. The updated Dysphagia Treatment doc includes all of the same information as the original document and adds to it clinical observations for each swallowing symptom/diagnosis as well as motoric and sensory innervations all placed in an easy to read six page chart. For purchase of $9.99 To purchase: click on the Paypal button below and don't forget to add your email address so the document can be emailed to you! Should you have any questions, or would like to request a sample page, please feel free to email me at amyreinsteinslp@gmail.com
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase. All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase. All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
Supraglottic Swallow
USE
To close the airway at the vocal fold level before and during the swallow and to clear residue after the swallow, delayed airway closure, reduced airway closure, delayed pharyngeal swallow, poor oral control of liquids with premature loss into the pharynx.
___ Only saliva swallow
___ Food/Liquid swallow
INSTRUCTIONS
1. Take a breath in.
2. Hold your breath after you inhale (lightly cover your tracheostomy tube, if present).
3. Keep holding your breath while you swallow.
4. Clear your throat immediately after swallow before breathing.
5. Swallow again.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
Hold your breath tightly. Now, swallow twice, release your breath with a sharp cough, and swallow again.
␣ Repeat this exercise five times.
References
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.
McConnel, F.M., Mendelsohn, M.S., & Logemann, J.A. (1987). Manofluorography of deglutition after supraglottic laryngectomy. Head and Neck Surgery, 5, 142-150
To close the airway at the vocal fold level before and during the swallow and to clear residue after the swallow, delayed airway closure, reduced airway closure, delayed pharyngeal swallow, poor oral control of liquids with premature loss into the pharynx.
___ Only saliva swallow
___ Food/Liquid swallow
INSTRUCTIONS
1. Take a breath in.
2. Hold your breath after you inhale (lightly cover your tracheostomy tube, if present).
3. Keep holding your breath while you swallow.
4. Clear your throat immediately after swallow before breathing.
5. Swallow again.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
Hold your breath tightly. Now, swallow twice, release your breath with a sharp cough, and swallow again.
␣ Repeat this exercise five times.
References
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.
McConnel, F.M., Mendelsohn, M.S., & Logemann, J.A. (1987). Manofluorography of deglutition after supraglottic laryngectomy. Head and Neck Surgery, 5, 142-150
Super-Supraglottic Swallow
USE
to increase anterior tilting of arytenoid and retraction of tongue base for patients who exhibit penetration into the airway with aspiration after the swallow
INSTRUCTIONS
Ask pt to inhale and hold their breath very tightly, bearing down. Then instruct pt t continue to hold breath lightly while swallowing. (immediately after the swallow the pt should cough to clear any residue)
Warnings: Pt's with high blood pressure should not do this manuever as bearing down may raise blood pressure.
References
Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.
Ohmae, Y., Logemann, J.A., Kaiser, P., Hanson, D.G., & Kahrillas, P.J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otology, Rhinology, and Laryngology, 105, 123-131.
to increase anterior tilting of arytenoid and retraction of tongue base for patients who exhibit penetration into the airway with aspiration after the swallow
INSTRUCTIONS
Ask pt to inhale and hold their breath very tightly, bearing down. Then instruct pt t continue to hold breath lightly while swallowing. (immediately after the swallow the pt should cough to clear any residue)
Warnings: Pt's with high blood pressure should not do this manuever as bearing down may raise blood pressure.
References
Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.
Ohmae, Y., Logemann, J.A., Kaiser, P., Hanson, D.G., & Kahrillas, P.J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otology, Rhinology, and Laryngology, 105, 123-131.
Shaker Manuever
USE
increase laryngeal excursion and width and duration of UES opening,
To strengthen muscles of the neck in order to facilitate opening of the bottom of the throat (e.g.- upper esophageal sphincter) for food passage.Patients who exhibit reduced upper esophageal sphincter opening and who demonstrate food residue in the pyriform sinuses.
INSTRUCTIONS
Lie flat on your back with no pillow under your head. Lift your head to look at your toes, while keeping your shoulders. Hold the position for 30 seconds and then release.
Do this 3 times
Lift your head and look at your toes and let your head go back down as if doing sit-ups for your neck.
Repeat this 30 times
Rest for one minute
Repeat this for two more sets of 30 for a total of 90 repetitions
Do the whole regimen at least 5 times per day.
Intensity is important in achieving improvement.
Warnings: Need MD clearance for patients with HTN, Cardiac problems or Cervical spine problems Patients with neck problems (e.g.- arthritis) may not be able to perform this exercise.
References
Easterling, C., Kern, M., Nitschke, T., Grande, B., Kazandjian, M., Dikeman, K., Massey, B.T., & Shaker, R. Restoration of oral feeding in 17 tube fed patients by the Shaker Exercise. Dysphagia, 15: 105, 2000.
Shaker, R., Kern, M., Bardan, E., Taylor, A., Stewart, E., Hoffmann, R.G., Arndorfer, R.C., Hoffmann, C., & Bonnevier, J.
Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. AJR, 272: G1518-1522, 1997.
increase laryngeal excursion and width and duration of UES opening,
To strengthen muscles of the neck in order to facilitate opening of the bottom of the throat (e.g.- upper esophageal sphincter) for food passage.Patients who exhibit reduced upper esophageal sphincter opening and who demonstrate food residue in the pyriform sinuses.
INSTRUCTIONS
Lie flat on your back with no pillow under your head. Lift your head to look at your toes, while keeping your shoulders. Hold the position for 30 seconds and then release.
Do this 3 times
Lift your head and look at your toes and let your head go back down as if doing sit-ups for your neck.
Repeat this 30 times
Rest for one minute
Repeat this for two more sets of 30 for a total of 90 repetitions
Do the whole regimen at least 5 times per day.
Intensity is important in achieving improvement.
Warnings: Need MD clearance for patients with HTN, Cardiac problems or Cervical spine problems Patients with neck problems (e.g.- arthritis) may not be able to perform this exercise.
References
Easterling, C., Kern, M., Nitschke, T., Grande, B., Kazandjian, M., Dikeman, K., Massey, B.T., & Shaker, R. Restoration of oral feeding in 17 tube fed patients by the Shaker Exercise. Dysphagia, 15: 105, 2000.
Shaker, R., Kern, M., Bardan, E., Taylor, A., Stewart, E., Hoffmann, R.G., Arndorfer, R.C., Hoffmann, C., & Bonnevier, J.
Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. AJR, 272: G1518-1522, 1997.
Masako
USE
Improves posterior pharyngeal wall by making contact with the BOT. Tongue is placed b/w teeth.
INSTRUCTIONS
Teeth with hold while swallowing.
The below 2 published studies examine the effectiveness of the Masako, however neither study supports the theory of improving TBR:
References
Fujiu M, Logemann J: E?ect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol 5:23-30, 1996: Authors concluded that the Masako improved posterior pharyngeal wall bulging which could improve pharyngeal pressure generation by making contact with the BOT.
Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Evaluation of manometric measures during tongue-hold swallows. American Journal of Speech-Language Pathology, 18, 65-73: Examined manometric measures during the Masako and concluded that while the technique should not be done during PO trials as it reduces oropharyngeal pressure generation, there may be increased pharyngeal constrictor strength after regular training.
Improves posterior pharyngeal wall by making contact with the BOT. Tongue is placed b/w teeth.
INSTRUCTIONS
Teeth with hold while swallowing.
The below 2 published studies examine the effectiveness of the Masako, however neither study supports the theory of improving TBR:
References
Fujiu M, Logemann J: E?ect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol 5:23-30, 1996: Authors concluded that the Masako improved posterior pharyngeal wall bulging which could improve pharyngeal pressure generation by making contact with the BOT.
Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Evaluation of manometric measures during tongue-hold swallows. American Journal of Speech-Language Pathology, 18, 65-73: Examined manometric measures during the Masako and concluded that while the technique should not be done during PO trials as it reduces oropharyngeal pressure generation, there may be increased pharyngeal constrictor strength after regular training.
Effortful Swallow
USE
increase BOT retraction and pressure during the pharyngeal phase of the swallow and reduce the amount of food residue in the valleculae of the throat & thereby possibly aspiration/penetration
INSTRUCTIONS
Swallow as hard as you can with food or saliva. Push as hard as you can with the tongue against the roof of your mouth while you swallow.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
References
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Shanahan, T.K., Logemann, J.A., Rademeker, A.W., Pauloski, B.R., & Kahrillas, P.J. (1993). Chin down posture effects on aspiration in dysphagic patients. Archives of Physical Medicine and Rehabilitation, 74, 736-739.
increase BOT retraction and pressure during the pharyngeal phase of the swallow and reduce the amount of food residue in the valleculae of the throat & thereby possibly aspiration/penetration
INSTRUCTIONS
Swallow as hard as you can with food or saliva. Push as hard as you can with the tongue against the roof of your mouth while you swallow.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
References
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Shanahan, T.K., Logemann, J.A., Rademeker, A.W., Pauloski, B.R., & Kahrillas, P.J. (1993). Chin down posture effects on aspiration in dysphagic patients. Archives of Physical Medicine and Rehabilitation, 74, 736-739.
| effortfulsw_forpt.pdf |
Mendelsohn Maneuver
USE
Increase laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening.Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening.
INSTRUCTIONS
1. Swallow normally. Feel the larynx (voice box) lift during the swallow.
2. On the next swallow, feel your larynx (voice box) elevating and hold it up with your neck muscles. Do not try to lift the larynx early. Let the larynx lift normally and then hold it up so that it does not drop for ___ seconds. Complete the swallow.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
References
Kahrilas, P.J., Logemann, J.A., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing. American Journal of Physiology, 260, G450-456.
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Logemann, J.A., & Kahrilas, P.J. (1990). Relearning to swallow post CVA: Application of maneuvers and indirect feedback: A case study. Neurology, 40, 1136-1138.
Increase laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening.Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening.
INSTRUCTIONS
1. Swallow normally. Feel the larynx (voice box) lift during the swallow.
2. On the next swallow, feel your larynx (voice box) elevating and hold it up with your neck muscles. Do not try to lift the larynx early. Let the larynx lift normally and then hold it up so that it does not drop for ___ seconds. Complete the swallow.
Perform with each food/liquid swallow.
Perform ___ times throughout the day.
References
Kahrilas, P.J., Logemann, J.A., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing. American Journal of Physiology, 260, G450-456.
Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.
Logemann, J.A., & Kahrilas, P.J. (1990). Relearning to swallow post CVA: Application of maneuvers and indirect feedback: A case study. Neurology, 40, 1136-1138.
| mendelsohnman_forpt.pdf |
BioFeedback
- EMG - electrodes placed on thyroid lamina while pt swallows and can visually see how strong/weak their swallow may be.
Muscle Stimulation
Newer techniques such as NMES and Vitalstim have been introduced and are more widely being used. See My Blog for recent studies. Though controversial, many clinicians feel they have seen change in their pt's with use of these types of protocols. They require training and certification.
- EMG - electrodes placed on thyroid lamina while pt swallows and can visually see how strong/weak their swallow may be.
Muscle Stimulation
Newer techniques such as NMES and Vitalstim have been introduced and are more widely being used. See My Blog for recent studies. Though controversial, many clinicians feel they have seen change in their pt's with use of these types of protocols. They require training and certification.
Bedside Swallow Examination
For Purchase is a one sheet, 2 sided Adult Bedside Swallow Examination which includes a full Oral Peripheral Examination, a brief Cognitive - Linguistic Examination taken from the Boston Diagnostic Exam and a full bedside Swallow Exam. The bedside swallow covers all possible boluses and physiological observations. The bedside swallow can easily be used and transferred as an official consult and is worth discussing with your apartment heads as it is a BIG time saver! Purchase this very handy one sheet Adult Bedside Swallow Exam for only $9.99 by clicking below and entering your e-mail address. Contact us at amyreinsteinslp@gmail.com with any questions.
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase.All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase.All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
Videofluoroscopy (VFFS)/Modified Barium Swallow Study (MBSS) Examination Report
For purchase is yet another time saver (aren't we always looking for ways to save time?!) This easy to read, easy to fill in VFFS form is structured to include all consistencies and all of the main physiologic components involved in a VFFS/MBSS Exam. There is also plenty of room for comments when there are unique findings. This two (2) page form is also a good study guide for students just starting out and wanting to learn about VFFS/MBSS. Purchase this very handy Videofluoroscopy Examination Report for only $11.99 by clicking below and entering your e-mail address. Contact us at amyreinsteinslp@gmail.com with any questions.
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase.All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
Once you purchase the items, you will then receive a confirmation e-mail from me stating that I received your purchase and it will then take 2 - 4 business days to process your payment via Paypal. Once your payment is complete, you will then receive a second e-mail from me containing your purchase.All orders can be RUSHED upon special request for an additional $7.00 fee. If you would like your orders to be rushed, simply select RUSH from the pull down Paypal menu OR e-mail me at amyreinsteinslp@gmail.com to set up your rush order. As soon as I receive confirmation that the payment has been set up (which is immediate), you can receive your items immediately!
