Vol. 27 • Issue 5
• Page 12
For many clients, feeding, eating and swallowing concerns are very complicated. There are always new strategies, and now it has become more important than ever to acquire specialized expertise in dysphagia evaluation and treatment.
Dysphagia services are covered under Medicare if safe and effective services are provided and performed by a licensed, qualified therapist. The American Occupational Therapy Association (AOTA) has a credentialing process for specialty certification in feeding, eating and swallowing that demonstrates the therapist's specialized knowledge and expertise (Cox, M. S., Roberts, P. I., Holm, S. E., Kurfuerst, S., Lynch, A., & Schuberth L., 2006).
Also supported in the occupational therapy scope of practice reported in the Occupational Therapy Practice Framework: Domain and Process developed by AOTA, occupational therapy includes management of feeding, eating and swallowing to enable eating and feeding performance.
Within a rehabilitation department you already may be fortunate to be a member of the interdisciplinary dysphagia team. In this team of experts, occupational therapy is responsible for communicating its role and working together with other experts that could include nursing, radiologists, physiatrists, dietitians, neurologists, speech therapists, gastroenterologists and others, in order to develop a dysphagia therapy program individualized to meet the needs of the client.
The occupational therapy dysfagia team at St. Mary's Hospital, Mayo Clinic, Rochester, MN. From left, Gina Christensen, MA, OTR/L; Julie Streib, OTR/L, holding a diagram of the esophagus; and Shari Bernard, OTD, OTR/L, SCFES, author and leader of the team.
If your therapy department is large enough, it may benefit from also having an occupational therapy team approach focused on dysphagia clients. In other words, having a few chosen OTs within your department to focus on this area of expertise. An OT dysphagia team will increase continuity with patient care while increasing awareness of occupational therapy to referring services.
Some other rewards it can bring include:
• developing individualized client dysphagia care,
• developing an evidence-based dysphagia practice,
• building professional rapport with the medical team, and
• gathering accurate statistics to provide an opportunity for the ability to accommodate and change occupational therapy practice with program outcomes.
In a given group of occupational therapists, there are only a few doing dysphagia evaluations and treatment within the hospital setting at any time. There is increased recognition and access to occupational therapy services as other medical team members become more familiar with the occupational therapy dysphagia staff and how they can access that staff.
In some health care institutions, an occupational therapy dysphagia team can be made up of two to three occupational therapists. Part of the development of the team also will require the participation of the rest of the medical interdisciplinary dysphagia team, including services such as physicians, nurses, radiologists, dietitians and others. This provides an opportunity for the OT department to collaborate with health care team members to provide the best patient care.
An OT team can help to build working relationships within the health care institution. You may need to provide education and awareness to the medical team about occupational therapy being vital for evaluation of dysphagia, education in diet modifications, treatment with swallow dysfunction, use of compensatory techniques and awareness of aspiration precautions and signs of aspiration. The OT team also can educate members of the health care team about the completion of dysphagia competencies that are in place to support the abilities and knowledge of the practicing occupational therapists within the hospital setting.
How to Begin
When developing an occupational therapy dysphagia team it is necessary to acquire OT staff with the correct qualifications and ability to demonstrate competencies in dysphagia practice. Once a core group of OTs is identified in your practice, it will be important to provide extensive dysphagia training within your hospital to maintain a standard of practice and comply with the demonstration of dysphagia competencies.
A training program can include forms of educational lectures, continuing education opportunities, and one-on-one observation and training of both clinical dysphagia evaluations and videofluoroscopic swallow studies. Clinical mentoring is a very important aspect within the training process, as this provides opportunities for demonstration of abilities and completion of competencies.
When training is completed, dysphagia competencies should be documented for each occupational therapist. The occupational therapy department can have continued refresher classes and annual dysphagia competencies for members of the dysphagia team to attend. A training program may consist of two weeks of lecture education with direct observation of clients with dysphagia, followed by three to six weeks of observation, plus technique demonstration with the already experienced and advanced dysphagia occupational therapist. Being a member of the dysphagia team offers the OT a chance to be completely immersed in dysphagia.
Once an occupational therapy dysphagia team has been established, your practice may want to consider having a clinical lead OT to maintain focus on research for updated, evidence-based practice. A clinical lead occupational therapist in dysphagia also provides a consistent leader in this area of expertise who is continuing to grow and have a significant impact on clients' quality of life.
An example of statistics to monitor may include the number of dysphagia evaluations being performed, results of videofluoroscopic swallow studies with regard to observed aspiration, where referrals for dysphagia evaluations are being initiated and what diagnoses are commonly associated with a dysphagia evaluation referral.
Occupational therapy programs that support and retain advanced-level dysphagia therapists are very important in the management of clients.
References available at www.advanceweb.com/OT or upon request.
Shari Bernard, OTD, OTR/L, SCFES, is lead clinical dysphagia occupational therapist in the department of physical medicine and rehabilitation at St. Marys Hospital, Domitilla 1, part of the Mayo Clinic in Rochester, MN.