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July 2005

July 2005 Volume 2 Issue 2

McGill Students Learn to Help People with Swallowing Problems

What is Dysphagia?

Dysphagia is the medical term used to describe a problem with swallowing food or liquids. Dysphagia is a common symptom of certain medical conditions, such as Parkinson’s disease, that can also lead to speech difficulties. People who have difficulty swallowing may not eat enough food to stay healthy. Dysphagia can also cause pneumonia if food or liquid gets into the lungs. The School of Communication Sciences and Disorders recently introduced a new course into its program in order to better prepare future speech-language pathologists to help people who have trouble swallowing. This course is being taught by David McFarland, an associate professor at l’Univerité de Montréal and an adjunct professor at McGill, and by James Lapointe, a Speech-Language Pathologist at Cité de la Santé in Laval.

The Role of the SLP

In North America, Speech-Language Pathologists (SLP) are dealing more and more with swallowing disorders. The role of the SLP in the assessment and management of dysphagia varies depending on where you live. In most of Canada and the United States, it is the role of the SLP to assess and treat dysphagia. In Quebec however, the assessment and treatment of dysphagia by SLPs is relatively new, and the role of the SLP depends on where you work. There are establishments where the SLP is the professional responsible for assessing and treating dysphagia. There are other establishments where swallowing disorders are the responsibility of the occupational therapist or dietician, with the SLP playing a collaborative role, a consultative role, or no role at all.

Professor Lapointe suggests that the ideal is a team approach in which professionals such as the physician, SLP, OT, and dietician work together to help the patient. Within such a collaborative approach, each profession contributes their specific expertise. SLPs are well trained to identify a swallowing problem, determine if the patient is at risk for getting food in the lungs, and plan therapy based on the cause of the dysphagia. A dietician can work with the patient and family to ensure that the patient is meeting his/her nutritional needs with the modified diet. An occupational therapist can facilitate the patient’s independence with feeding, using a variety of strategies (e.g.,. adapted utensils, positioning during meals). In Quebec, a discussion group, formed with representatives from all three professions, is trying to reach an agreement about how the evaluation and management of dysphagia should occur.

New Dysphagia Course at McGill

Speech-Language Pathology students have always had comprehensive training in the anatomy, physiology, and neurology of structures involved in both speech production and swallowing. Recently, the Canadian Association of Speech Language Pathologists and Audiologists (CASLPA) recommended that all speech-language pathology programs in Canada introduce such a course in order to meet the demand for SLPs with this specialized training. This past year, for the first time, the School of Communication Sciences and Disorders offered its SLP students a full course dedicated to the assessment and management of dysphagia. The introduction of this course reflects a growing awareness that dysphagia is a large part of adult SLP practice in most of North America. The graduating class of 2005 was the first to take this course. Comments from students were positive: “The course definitely prepared me for my placement and gave me a strong knowledge base. It was a very clinically oriented course, which was great”. The course included a review of the anatomy and physiology of the swallow and also provided many case studies and examples to help the students apply their previously acquired knowledge of the speech, voice, and language mechanisms to the assessment and treatment of swallowing disorders. Students learned about the possible underlying causes of dysphagia, the problems that can result from dysphagia, how to evaluate a patient suspected of having swallowing problems, and how to set up a treatment plan for a patient with dysphagia. SLPs trained at McGill are now well prepared to evaluate and develop treatment plans that will benefit both the speech and swallowing problems of their patients through a more integrated, holistic approach.

Lisa Hargraves, a SLP at the Jewish General Hospital in Montreal, graduated from McGill before the dysphagia course was introduced. As a result, she admits that the role of the SLP in dysphagia management was not immediately clear to her. Following two internship placements, a course, and work experience, she says it is now very clear: SLPs can directly apply their knowledge of voice disorders, motor speech disorders, and the anatomy and physiology of speech to the assessment and treatment of dysphagia.

More information for speech-language pathologists (in French only) can be found here:M

Lapointe, J., & McFarland, D. (2004). Pourquoi les orthophonistes devraient-ils s'intéresser à la dysphagie?, Fréquences, 16 (3), 22-25.

How to Identify and Help Adolescents with Language Disorders

John is a 15 yr old boy with few friends, and is known by his teachers for his “class clown” behavior, rather than his good grades. In fact, despite his best efforts, he receives low grades in many of his classes. His mother complains that John often does not follow instructions that she gives, and reports that he has trouble making and keeping friends. Many teachers have had students like John in their classroom at some point in time. The reality is that what may be attributed to a behavioral problem in an adolescent could actually be a red flag for a language disorder.

Language disorders in adolescents can be associated with difficulties in a number of different areas, such as the ability to learn and function successfully in a classroom setting, social relations, and self-esteem.

Characteristics of language disorders in adolescents may include (but are not limited to):

  • Problems with organization of thoughts and ideas for narrative discourse (e.g. recounting events, experiences, stories, following a story line)
  • Limited or poor vocabulary
  • Problems with pragmatic language skills (the way that language is used in different situations)
  • Poor topic initiation and/or maintenance (e.g., not starting conversations, getting off topic quickly)
  • Difficulties with making inferences and interpreting non literal language (puns, idioms, sarcasm, etc.)
  • Problems with language comprehension (understanding instructions)

Ideas for parents and teachers to help improve narrative comprehension skills of adolescents

[Source: Reah Paul (2001). Language disorders from infancy through adolescence: Assessment & intervention (2nd Ed). USA: Mosby.]

If the adolescent is reading a book, a magazine article, or a comic book:

  1. Ask the adolescent the title of the reading material and discuss unknown and known meanings of words in the title (and/or in the text).
  2. Ask the adolescent to try and generate ideas about a story’s topic (prior to reading the story) from reading the story’s title.
  3. Ask for reasons why the adolescent is making these predictions about the story’s topic.

Once the book, magazine, article, comic book has been read:

Ask the adolescent to identify the story elements by asking questions about the story based on his/her level of narrative functioning. Example questions may include:

  1. Where did the story take place?
  2. Who were the most important people in the story?
  3. What is the problem in the story?
  4. How did the story end?

For further suggestions about helping adolescents with suspected language difficulties, contact your local resource teacher, or SLP