IOPI Medical Q2 2023 Newsletter - Earn ASHA CEUs with Our Two Free Courses and Visit Us At AVASLP!

Spring in the Pacific Northwest is always an interesting time. We often experience all four seasons, sometimes all within a single day! The cherry blossoms make an appearance and the air is filled with the scent of the earth slowly waking up again.

Before COVID, for IOPI Medical Spring meant gearing up for another year of conferences and getting to spend time with you, our devoted customers. We have greatly missed this annual ritual but are thrilled to announce that we are back on track and are looking forward to not only AVASLP in April, but also ASHA in Boston! Come find us and say hello. We’d love to see you!

Don’t forget to visit our always-evolving website. We are continuing to make improvements, giving you the opportunity to interact with our IOPI staff, Patient Advocacy tools, and COVID-19 resources. You can also follow us on Instagram (iopimedical), Twitter (@iopimedical) & Facebook (IOPI Medical LLC) for the latest news and information.

Please Note: IOPI Medical offices will be closed on May 29th in observance of Memorial Day.

As many of you have already experienced, you can now earn ASHA Continuing Education Units by attending our two FREE courses. The Role of Oral Musculature in Swallowing and the Therapeutic Benefits of the IOPI, will review the oral musculature and its essential functions, as well as explore exercise principles and how the IOPI can be integrated into a dysphagia treatment plan.

Our second course, Research Update, summarizes recent findings related to the IOPI. Both courses are hosted by our Clinical Consultant, Ed Bice.

Click the button below to register!

Food provides animals the nutrients needed to grow and maintain life. When most animals feed, they consume foods necessary to maintain their well-being and do so similarly at each feeding. Humans, however, do not feed. Humans eat. The way humans relate to food is unique. This trait distinguishes humans from other animals (Almerico, 2014). Eating and drinking are more complex than providing nutrition and hydration (Argyle & Martin, 1991; Sučić et al., 2019). Kittler et al. (2012) suggested: "eating is a daily reaffirmation of [one's] cultural identity." Many people associate the foods from their culture with warm feelings and memories. Food ties people to their families and holds a particular worth. When frustrated or stressed, people often chose to consume the comfort foods associated with their culture (Almerico, 2014). In addition, evidence indicates that those who eat socially more often feel happier and express greater satisfaction with life. The same people are more trusting of others, more engaged with their local communities and have more dependable friendships. Data suggests that the causal direction runs from eating together to bondedness rather than the other way around (Dunbar, 2017). In a systematic review, a few of the most frequently cited dimensions of food that bring pleasure included sensory experiences, food variety, the place where food is eaten, and memories associated with eating (Bédard et al., 2020). In another study (Diener et al., 2010), eating correlated to happiness.

People have developed a complex relationship with food and food choices throughout life (Almerico, 2014). When an illness results in a swallowing problem, the ability to interact with food in the desired manner may be lost or taken away. Many well-meaning clinicians and institutions require people with swallowing difficulties to follow recommendations about what can and cannot be eaten. In a 2005 survey of speech-language pathologists, respondents prescribed thickened liquids for up to 75% of patients with dysphagia (Garcia et al., 2005). Another study of clinicians who treat swallowing disorders found texture modification to be the most frequently recommended intervention (used by 83% of respondents), followed by thickening liquids (78% of respondents)(McCurtin & Healy, 2017).

Although altering foods and liquids is common in the treatment of people with swallowing disorders, research does not currently support the practice. Andersen et al. (2013) examined the evidence related to diet modifications and aspiration pneumonia. The authors concluded there is no high-level evidence to indicate that thickened fluids prevent aspiration pneumonia in chronic dysphagia. The investigators did not find enough evidence to make recommendations concerning modified food. Additionally, Steele et al. (2015) described the sparse amount of research available concerning the modification of solids as "disappointing." Another systematic review by Beck et al. (2017) concluded, "no literature was identified that addressed the effects of using texture-modified food consistencies as a compensatory strategy to facilitate safe and efficient intake of foods." The authors could not identify research to explain the effects of "moderately thick or extremely thick" liquid levels. After examination of the current evidence O'Keeffe (2018) concluded that the "disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients." Although there appears to be a lack of information concerning the benefits of altered diets and liquids, there is an emerging body of evidence concerning the possible negative consequences (Bahouth et al., 2018; Bennett, 2000; Cichero, 2013; Gosa, 2011; Maughan, 2003; Miles et al., 2018; Rowat et al., 2012; Saunders & Smith, 2010; Sura et al., 2012; Vigano, 2011; Wittbrodt & Millard-Stafford, 2018; Wright et al., 2005).

A rehabilitative approach can replace diet-focused treatment. People with swallowing disorders may be better served by participating in interventions that have the potential to rehabilitate their dysfunction. A rehabilitative approach requires the clinician to have a knowledge base that will support critical thinking (Bice & VanSickle, 2021; Willingham, 2019). Clinicians supporting people with swallowing disorders would benefit from a strong understanding of anatomy and physiology, exercise principles, motor learning principles, and neuroplastic principles. Stay tuned for the next newsletter to take a deeper dive into each of the areas.

The AVASLP conference will be back in-person this year, and so will IOPI Medical!! We can’t wait to see you all again!

A variety of topics related to the practice of speech-language pathology will be included this year. Topics include assessment and treatment of acquired speech and language disorders, traumatic brain injury, dysphagia, voice disorders and laryngectomy, progressive neurological disease, and the use of assistive technology in persons with cognitive and communication impairments.

For more information, please click the button below:

To help you achieve the greatest level of success for your patients, we continue to provide you with the necessary Purchasing Advocacy tools, as well as clinical support.

Our Purchasing Advocacy tools can be found on our Medical Professionals page. Here you will find our IOPI Dysphagia Cost Tool as well as a ready-to-use Benefits of IOPI for Dysphagia PowerPoint. Just populate it with information specific to your patient’s needs.

You also have clinical support at your fingertips. Our clinical consultant, Ed M. Bice, M.Ed., CCC-SLP, is available to mentor through the advocacy process to assess and report the estimated cost of dysphagia to your facility. You can reach Ed for a patient consultation or clinical question by calling (844) 844-IOPI or emailing ed@iopimedical.com.

To access our IOPI Dysphagia Cost Tool, the Benefits of IOPI for Dysphagia PowerPoint, and tips on advocating for your patients, please visit: https://iopimedical.com/purchasing-advocacy/

Lastly, we are not currently scheduling any future webinars as we are focusing on the previously mentioned ASHA CEU course. So exciting!

Often clinicians who evaluate and treat swallowing find their own literature lacking. Clinicians must find information from outside sources when faced with such a conundrum. As allied health professionals working in medical settings, guidance can often be found in medical journals. The articles highlighted speak to the necessity of obtaining informed consent from people concerning procedures and treatments. Clinicians who assess and treat swallowing often make treatment recommendations that include modification of diets and liquids which can result in adverse effects. Obtaining consent prior to making such changes is required by law and ethics. The information summarized below offer guidance in this area of practice.

The articles below are only a small fraction of the number of IOPI-related studies in general. You can find many more, covering a variety of topics, by visiting https://iopimedical.com/studies/ or clicking the button at the end of the section.

Effective Informed Consent Communication skills for Senior Medical Students

Robb, K., Zembrazuska, H., Rosenbaum, M. (2023). Effective Informed Consent Communication skills for Senior Medical Students (Sub-Interns). Patient Counseling and Education 109s p 21.

https://www.sciencedirect.com/science/article/abs/pii/S0738399122005298

Obtaining informed consent from patients for medical decisions is an essential task for healthcare providers. To make informed decisions, practitioners must use effective communication skills to ensure that patients understand the possible positives and negatives of potential outcomes. Several studies have demonstrated that interns lack the skills to conduct these conversations. The investigators developed an educational intervention on effective informed consent communication skills. Each student engaged in a consent conversation with a simulated patient while their cohort observed. A debriefing and learner feedback followed the session. The investigation included a pre and post-score. Participants completed a survey following the exercise. All participants indicated that practicing, receiving feedback, and observing others helped enhance their skills.

Is the Current Informed Consent Model Flawed?

Heinrichs, B., Ergin Aslan, S. (2022). Is the Current Informed Consent Model Flawed?. In: Faintuch, J., Faintuch, S. (eds) Integrity of Scientific Research. Springer, Cham.

https://doi.org/10.1007/978-3-030-99680-2_55
https://link.springer.com/chapter/10.1007/978-3-030-99680-2_55

Informed consent is a principle that plays a crucial role in research ethics and medical ethics. Empirical findings and theoretical considerations suggest the current informed consent model may be flawed. Specifically, the understanding of information disclosed to patients and research participants during the consent process is incomplete. The lack of education during consent conversations casts serious doubt on the validity of the consent. The paper reviews the current state of informed consent and discusses why it may be inadequate. The authors provide suggestions to improve the current model of informed consent.

Informed Consent in Patients with Frailty Syndrome

Silbert BS, Scott DA. Informed Consent in Patients with Frailty Syndrome. Anesth Analg. 2020 Jun;130(6):1474-1481. doi: 10.1213/ANE.0000000000004629. PMID: 32384337.

https://pubmed.ncbi.nlm.nih.gov/32384337/

Frailty is present in more than 30% of individuals older than 65 who require medical care. Frailty poses many unique issues in the informed consent process. These individuals have an increased incidence of poor outcomes. Material risks are not generally factored into conventional risk predictors, so individuals with frailty may never be fully informed of the actual risk for procedures. While the term “frailty” has the advantage of alerting healthcare practitioners to the potential for increased adverse outcomes, it has the social disadvantage of encouraging objectivity to ageism. The diagnosis may result in paternalistic behavior. Such behavior may encroach on self-determination and manifest as coercion, thus compromising autonomy. An increased time commitment should be recognized. The gap between theoretical goals and practice of informed consent should be acknowledged.