Dysphagia Research Bites

When a patient can’t swallow their tablets, the conversation often ends with “take it with yoghurt” or “check with the pharmacist if it can be crushed.” But what happens to the medication, and the person, after that?  Clinical Pharmacist Mike Hewson joins Chantelle on Dysphagia Research Bites to unpack the medication misadventures that can follow when tablets are cut, crushed or hidden in food, and why speech pathologists and pharmacists keep handballing a problem that belongs to both professions.  In this episode we cover: What a “medication misadventure” actually is and why older adults on multiple medications are most at riskWhy “is it coated?” is not enough to decide whether a tablet can be crushedWhat can be lost when medications are cut, crushed or opened, and which drugs leave very little margin for errorThe problem with mixing medications into food and thickened fluids, and why keeping food and medicine separate matters for enjoyment and dignityHow home medicines reviews work and why a pharmacist in your client’s life can be your best allyA screening tool for pill swallowing difficultyMedications that cause drowsiness or dry mouth and may be making swallowing harderWhy pill swallowing has been called an “orphan task”, and what real interdisciplinary collaboration could look like The publication this episode is based on:Lau, E. T. L., Steadman, K. J., Cichero, J. A. Y., & Nissen, L. M. (2018). Dosage form modification and oral drug delivery in older people. Advanced Drug Delivery Reviews, 135, 75–84. https://doi.org/10.1016/j.addr.2018.04.012 Other resources mentioned in this episode:PILL-5 Questionnaire: -       Pdf copy: https://tiglutik.com/wp-content/uploads/2020/07/PILL-5-Screening-Questionaire.pdf-       Online version: https://gloup.com.au/pill-5-assessment TGA Approved Medication lubricants:-       https://gloup.com.au-       https://tabletease.com.au For more clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Is it a case of trouble with swallowing or trouble with eating? In this episode, Dr Megan Parsons, medical speech-language pathologist, unpacks a framework that changed how she thinks about swallowing problems. Chantelle and Megan explore why “dysphagia” isn’t always a problem of the swallow itself, and why working out what is driving the difficulty might be the most important clinical question we ask.If you’ve ever documented “dysphagia” without being sure what was driving it, this episode is for you. In this episode we cover:What cognitive dysphagia is, and what it looks like at mealtimesWhy a patient can have intact swallowing anatomy and physiology and still not eatWhether “cognitive dysphagia” belongs across populations, including adults with developmental and intellectual disabilityA systems-based framework for dysphagia and how it shifts assessment, chart review and documentationWhen the swallow isn’t the problem, and how to flag concerns outside our scope without handballing the patientHow to look for respiratory contributors to dysphagia during a clinical swallow evaluationHow to see natural eating behaviour in a hospital setting, and why involving family mattersThe role of clinical reasoning in what makes us pathologists, not just therapists The publication this episode is based on:Winchester, J & Winchester, C (2015). Cognitive dysphagia and effectively managing the five systems. Perspectives on Gerontology, 20(3), 116–132.You can access the article here: http://dysphagiamanagement.com/wp-content/uploads/2015/03/CognitiveDysphagia_Winchester_2015.pdf For more clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Safety, nutrition, enjoyment and the dining experience all need to be part of the conversation when we are talking about texture modified meals in aged care. In this episode of Dysphagia Research Bites, Chantelle sits down with Vanessa Chan to unpack a mixed methods study looking into these very things. They explore the whole journey of a meal, from the kitchen to the dining room, and what speech pathologists can do to influence it. In this episode we cover:Why the whole mealtime workflow matters, from preparation and labelling through to serving and feeding assistanceWhether texture modified diets are being over-prescribed, and what happens when recommendations are changed without an SLP reviewWhy an instrumental assessment isn't always feasible in the community and aged care, and what that means for practiceThe problem with texture modified menus: limited variety, inconsistent quality and nutritional gapsHow access to drinks, thickening practices and staff training can affect residents' hydration and safetyWhy some residents choose to avoid the dining room, and how our own assumptions as clinicians can get in the wayHow well IDDSI has been implemented in practice, and what needs to improveWhy choking risk deserves more attention in our profession The publication this episode is based on:Wu, X., Yousif, L., Miles, A., & Braakhuis, A. (2022). Exploring meal provision and mealtime challenges for aged care residents consuming texture-modified diets: A mixed methods study. Geriatrics, 7(3), 67. https://doi.org/10.3390/geriatrics7030067. PMID: 35735772. Additional resources for aged care providers can be found at Swallowing and Dysphagia Support: https://www.swallowinganddysphagiasupport.com.au For more community-based clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

How many times does your patient swallow in a minute? It sounds like a simple question but the answer might tell you more than you'd expect. In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Sonal Pathak to explore spontaneous swallowing frequency: what it is, how it's measured, and why it could become one of the most practical objective tools in your clinical toolkit, both at the bedside in hospital and out in the community. In this episode we cover: The difference between spontaneous and volitional swallows, and why this distinction matters for how you measure themWhy the measurement environment needs to be carefully controlled — and what can accidentally inflate your dataHow long you actually need to record (the answer may surprise you)The role of spontaneous swallowing frequency as a screening tool in acute care, and what makes it accessible to non-SLP staffWhy Sonal's doctoral research focused on this measure as an outcome measure in a post-acute setting and what that means for how we evaluate treatment effectivenessWhy this measure may be particularly useful for clients with mild or subclinical dysphagia where other clinical signs are absent  One of the publications this episode is based on:Crary, Carnaby & Sia (2013): https://pubmed.ncbi.nlm.nih.gov/25088166/ For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

What if you could interpret a video fluoroscopy report the way a doctor reads a blood test, with clear reference ranges, and the ability to say with confidence whether a value is within or outside what's expected for a healthy adult? That's exactly what Dr Catriona Steele and her team at the University of Toronto have been working on, and in this episode she walks us through what they've found. In this episode we cover:What prompted the development of VFSS reference values.How the ASPEKT method differs from ordinal rating tools like MBSImP and what it means to measure swallowing rather than describe itWhat the reference data tells us about residue, and why ASPEKT's approach to measuring residue is conceptually different from the Bolus Clearance Ratio and DIGESTThe 2D vs 3D measurement problem: the validity challenges of pixel-based area measures and what Catriona's team is doing about itHow many thin fluid swallows you actually need before you can confidently rule out aspiration and whether consecutive sips countWhy bolus position at swallow onset was dropped from the reference value framework  and what replaced itWhat emerging ASPEKT data is showing across clinical populations including Parkinson's disease and COPDASPEKT Academy and the clinical workshop coming to Australia The publications this episode is based on:Steele, C. M., Peladeau-Pigeon, M., Barbon, C. A. E., Guida, B. T., Tapson, M. S., Valenzano, T. J., & Waito, A. A. (2023). Reference values for videofluoroscopic measures of swallowing: An update. Journal of Speech, Language, and Hearing Research, 66(8), 2758–2773. https://doi.org/10.1044/2023_JSLHR-22-00608Updated 2026 Reference Values available here: https://figshare.com/s/428ddbd2d1d009abcd01Register for upcoming ASPEKT VFSS Workshops Here:https://steeleswallowinglab.ca/srrl/education/aspekt-academy/#:~:text=ASPEKT%20Academy%20is%20a%202%2Dday,be%20offered%204%20times.%20The For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course