Dysphagia Research Bites

What does it actually look like to assess swallowing difficulties in an adult who has eaten a certain way their entire life, and whose "textbook" may look nothing like yours? In this episode of Dysphagia Research Bites, Chantelle sits down with Jen Biener, a speech-language pathologist specialising in adults with developmental disabilities, to dig into a Dutch retrospective study on the prevalence and associated factors of swallowing difficulties in adults with intellectual disabilities aged 50 and over — and to unpack what it really means to assess and support this often-overlooked population. In this episode we cover:Why the terminology we use — dysphagia vs. feeding and swallowing difficulties — matters clinically and in research, and why both terms have a place depending on the settingHow to conduct a meaningful mealtime assessment, including the value of observing familiar caregivers feeding the person rather than jumping straight to a formal evaluationWhy mealtime dependency needs to be understood differently in people who have always been dependent for feeding, compared to someone who acquired that dependency after a strokeChoking risk assessment in this population, including the limitations of existing tools and the power of instrumental assessment as a biofeedback toolHow to set people up for success before and during instrumental swallowing studies The importance of clinical language: writing what you observe, not what you assume, and why "did not follow one-step commands" is very different from "cannot follow one-step commands"Assessment tools and approaches Jen recommends, including the Dysphagia Disorder Survey, the Choking Risk Assessment, and the Functional Communication Profile - RevisedWhy there is so little research on adults with intellectual disabilities, and why this population is, in many ways, historically new  The publication this episode is based on:Sanders KJV, Elbers RG, Bastiaanse LP, Echteld MA, Evenhuis HM, Festen DAM. Prevalence of swallowing difficulties and associated factors in older people with intellectual disabilities. J Appl Res Intellectual Disability. 2024 May;37(3):e13209. doi: 10.1111/jar.13209. PMID: 38382915: https://pubmed.ncbi.nlm.nih.gov/38382915/ Other resources mentioned in this episode:Dysphagia Disorder Survey (DDS)  & Dysphagia Management & Staging Scale: https://sites.google.com/view/dysphagiaorg/the-dysphagia-disorder-surveyChoking Risk Assessment & Pneumonia Risk Assessment: https://pubmed.ncbi.nlm.nih.gov/28822297/Article on mealtime supports for people with ID: https://pubmed.ncbi.nlm.nih.gov/21988217/Functional Communication Profile — Revised: https://www.wpspublish.com/fcp-r-functional-communication-profile-revised For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

If there's one thing that hasn't aged well in dysphagia management, it's the idea that swallowing is only a reflex. Over the past few decades, our understanding of cortical control in swallowing has fundamentally shifted, and so have our approaches to rehabilitation. In this episode, Professor Maggie-Lee Huckabee walks us through that evolution: from reflex-based compensation, to muscle strengthening, to where we are now: skill-based training that targets neural networks and motor planning. We also get into the practical side of surface EMG biofeedback, what it actually is, how it differs from NMES, and how to use it clinically. In this episode we cover:The distinction between sEMG and NMES How our understanding of cortical control in swallowing has evolved, and what that means for how we approach rehabilitationThe shift from compensation-based approaches to muscle strengthening, and then to skill-based trainingThe importance of the cranial nerve examination in directing our rehabilitation approachHow skill-based swallowing impairments might look on VFSSPractical application of sEMG biofeedbackBiSSkApp: an sEMG biofeedback system that patients can use at home while clinicians can have remote access to data The publication this episode is based on:Huckabee, M-L., Mills, M., Flynn, R., & Doeltgen, S. (2023). The evolution of swallowing rehabilitation and emergence of biofeedback modalities. Current Otorhinolaryngology Reports, 11, 144–153. https://doi.org/10.1007/s40136-023-00451-8 Where to find the resources mentioned:BiSSkApp by Swallowing Technologies (SwalTech): https://swaltech.com/bisskapp/For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

If you're a speech pathologist working in the community, particularly in Australia or with adults with developmental disabilities, this episode is for you. But if you work with risk feeding plans in any setting, including the UK, there's plenty here that will resonate too.In this episode of Dysphagia Research Bites, Chantelle hosts a panel discussion with speech pathologists: Meredith Lane, Niall Taylor, Anna Coates, and Dr Lillian Krikheli, to unpack one of the most clinically and ethically complex areas in our field: Eating and Drinking with Acknowledged Risk (EDAR). The panel explores why this practice looks so different across countries, settings, and service systems and follows on from a previous episode on the same topic, but with a guest with a medical background.In this episode we cover:The differences in terminology across countriesHow community and hospital settings approach EDAR differently — and why community SLPs often bear the brunt of overly risk-averse policiesHow supported disability accommodation settings can inadvertently remove client autonomy and de-skill individualsWhy business decisions — not clinical ones — are often driving restrictive mealtime policies in community organisationsWhat coroner's reports actually tell us about SLP accountability in dysphagia-related incidentsThe concept of dignity of risk and how to balance it with duty of careWhy risk to pleasure, social engagement, and identity deserves as much attention as aspiration riskThe problem with waivers and how they oversimplify complex clinical decisionsWhat patient-centred decision-making actually looks like in practiceAdditional Resources:You can find more information on Eating & Drinking with Acknowledged Risk here:https://www.rcslt.org/members/clinical-guidance/eating-and-drinking-with-acknowledged-risks-risk-feeding/https://www.speechpathologyaustralia.org.au/Common/Uploaded%20files/Smart%20Suite/Smart%20Library/1b67af79-1074-4a30-a9a0-61f3eccb7b2d/20200221%20Position%20Statement%20Risk%20Feeding.pdfFor clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

The guidelines say to manage risk. But what if the guidelines are the problem? In this episode of Dysphagia Research Bites, Dr Shaun O'Keeffe and I unpack his critique of the Royal College of Physicians' guidance on eating and drinking difficulties, and we ask the question that too few clinicians are asking: is our fear of aspiration actually driving good practice, or just driving restriction?In this episode we cover:The difference between aspiration and aspiration pneumonia, and why conflating them causes harmWhy dietary modifications and thickened fluids are not evidence-based strategies for preventing pneumoniaThe BOLUS Framework and why Shaun takes issue with how it frames riskWhy "unsafe swallow" is a term that needs to goThe evidence, or lack of it, behind nil by mouth orders for dysphagic patientsInformed consent, patient choice, and why quality of life has to be part of the conversationWhy the profession is at a crossroads between risk-averse practice and evidence-based careThe article this episode is based on:O'Keeffe, Shaun & Murray, Aoife & Leslie, Paula & Collins, Lindsey & Lazenby-Paterson, Tracy & Mccurtin, Arlene & Mulkerrin, Siofra & Smith, Alison. (2021). Aspiration, risk and risk feeding: A critique of the royal college of physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing. 1-10. 10.3233/ACS-210031. For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

If you've ever felt uncertain about whether cervical auscultation belongs in your clinical toolkit, this episode is for you. In this episode of Dysphagia Research Bites, Chantelle sits down with Associate Professor Liza Bergstrom to unpack the evidence behind cervical auscultation, why it became so controversial, and why recent high-quality research suggests it deserves a proper place in your clinical swallow evaluation. In this episode we cover: ·      What cervical auscultation actually is and where to place the stethoscope·      Why CA became controversial and why that controversy may have been based on a misunderstanding of its intended purpose·      The five key components to listen for during oral trials using the Respiratory Swallow Assessment Protocol·      How CA complements the clinical swallow exam rather than replacing instrumental assessment·      What the research says about validity, accuracy and reliability of CA compared to FEES·      The role of training in improving reliability and what training options are available·      Whether CA can detect silent aspiration and what its limitations are The publication this episode is based on:Bergström L, Cichero J, Jaghbeer M, Sutt AL. Respiratory-swallow assessment protocol for adult dysphagia management. BMC Res Notes. 2025 Nov 27;19(1):60. doi: 10.1186/s13104-025-07509-4. PMID: 41310723; PMCID: PMC12903235. If you'd like some further reading on CA, please check out the articles below:https://link.springer.com/article/10.1007/s00455-022-10468-8https://www.tandfonline.com/doi/full/10.1080/17549507.2021.1953592#abstracthttps://onlinelibrary.wiley.com/doi/full/10.1111/coa.14202?msockid=077fa973c35469500a04bf97c2d968d3https://pubmed.ncbi.nlm.nih.gov/30019178/https://www.asha.org/siteassets/uploadedfiles/icf-swallowing.pdf If you’ve been on the fence about CA or you’ve written it off, this episode is for you!For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

In this episode, Chantelle sits down with Tiffani Wallace, a dysphagia specialist with a passion for rehabilitation, to break down a 2016 case series study on the Intensive Dysphagia Rehabilitation Approach (IDRA) ™ in patients with neurogenic dysphagia.In this episode they cover:What the IDR approach actually involves and why it's more accessible than it soundsThe three core components of the program: oropharyngeal exercises, high intensity targeted swallowing practice and adherence-inducing featuresThe principles of neuroplasticity underpinning the approach — and how to apply them in everyday practiceWhy focused, targeted exercises beat a long list of unproven techniques every timeWhy 60 bolus swallows per day is less daunting than it sounds — and why it mattersBe sure to check out Tiffani's work at www.dysphagiaramblings.net or find her on Instagram at @dysphagia_ramblings.The publication this episode is based on: Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K. The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study. Arch Phys Med Rehabil. 2016 Apr;97(4):567-574. https://doi.org/10.1016/j.apmr.2015.11.019Note: DPNS stands for Deep Pharyngeal Neuromuscular StimulationFor clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

In part 2, Chantelle continues her conversation with Jackie Rodriguez, SLP, picking up where they left off on the dual diagnosis of dysphagia and dementia.In this episode they cover:How dementia affects the visual field and what this can mean at mealtimesPractical approaches to assessing vision and how you can compensate for these impairments in your management approachUsing sensory strategies at mealtimes, including how something as simple as separating food into individual bowls can support attention and reduce overwhelmEnteral feeding and what the evidence actually says about whether it prevents aspiration pneumoniaJackie's approach to oral apraxia: the tips, tricks and techniques she uses in practiceProactive swallowing therapy and why early intervention matters in this populationThe hill Jackie dies on when it comes to dysphagia care at end of lifeBe sure to check out Jackie's ebook: The SLPs Guide to Dementia which you can access through Teachers Pay Teachers or through her instagram page: @unlearnwithme.theslpThe publication this episode is based on: Dysphagia in Persons with Dementia: The Dual Diagnosis Challenge Author: Michelle Tristani Publication: Perspectives of the ASHA Special Interest GroupsVolume 1, Number 15, Pages 105-116https://doi.org/10.1044/persp1.SIG15.1For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Dysphagia & Dementia: What we need to learn & unlearnIf you're a speech pathologist working with adults with dementia, you already know that dysphagia doesn't show up in isolation. It shows up alongside memory loss, behavioural & sensory changes, communication breakdowns and alongside an aging swallow.In part 1 of this episode of Dysphagia Research Bites, Chantelle sits down with Jackie Rodriguez, Speech-Language Pathologist, to unpack the dual diagnosis challenge of dementia and dysphagia, and why assessing swallowing in this population requires a fundamentally different clinical lens.In this episode we cover:Why dementia and dysphagia together present a unique and underrecognised clinical challengeJackie's story of how this became an area of interestAn introduction to the article: Dysphagia in Persons with Dementia: The Dual Diagnosis Challenge by Michelle TristaniA discussion on terminology and why the language we use with this population mattersFunctional approaches to assessing dysphagia in adults with dementiaSome cognitive assessments that SLPs should know about Assessments mentioned in this episode:Dementia Mealtime Assessment Tool (DMAT)Environment & Communication Assessment Toolkit (ECAT) for Dementia CareThe Saint Louis University Mental Status (SLUMS) The Mini Mental State Examination (MMSE)Cognitive Linguistic Quick Test (CLQT)Global Deterioration Scale (GDS)Be sure to check out Jackie’s ebook: The SLPs Guide to DementiaYou can find it here: https://www.teacherspayteachers.com/Product/The-SLPs-Guide-to-Dementia-11781923The publication this episode is based on: Dysphagia in Persons with Dementia: Tristani, M (2016). The Dual Diagnosis Challenge. Perspectives of the ASHA Special Interest GroupsVolume 1, Number 15 Pages 105-116https://doi.org/10.1044/persp1.SIG15.105For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

If you're a speech pathologist working in the community, you already know it feels different to the hospital. But did you know the research actually backs that up? In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Simone Howells from Griffith University to unpack her research on community-based dysphagia practice and why the skills that made you great in the hospital might need a rethink when you step into someone's home. In this episode we cover: Why community-based dysphagia care requires an adapted skillset and mindsetThe three key themes from Simone's research: holistic practice, client autonomy, and carer engagementThe unique challenges of working without a multidisciplinary teamHow grief, loss, and psychosocial factors show up in community dysphagia practiceWhy new graduates may feel underprepared for community roles — and what universities are doing about itThe importance of curiosity and conversation over rushing straight to assessmentCultural considerations in community dysphagia careWhere the research gaps are and why community practice deserves more attentionThe publication this episode is based on: Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. Int J Lang Commun Disord. 2019 Nov;54(6):971-981. doi: 10.1111/1460-6984.12499. Epub 2019 Sep 3. PMID: 31479197.Where to find the resources mentioned:Beyond the Blender cookbook (second edition): www.beyondtheblender.com.auGoal-setting handout: https://dysphagia-bites.kit.com/interviewguideFor clinical resources and evidence-based dysphagia education beyond the podcast, head to www.dysphagiabites.com