Curriculum for Adult and Pediatric Dysphagia Course

From my previous post, there is conversation that SLP students at the Master's level may not be receiving adequate instruction and hands-on training in the area of pediatric dysphagia. More instruction leans towards adult dysphagia which contrasts from pediatric dysphagia significantly in many ways. For example, treating a premature infant for dysphagia is much different from treating an elderly man who has suffered a stroke. Below is a draft of a 4 hour credited course that address pediatric dysphagia for half of a semester and adult dysphagia the other half. Tell me what you think!

Pediatric Dysphagia

Course Purpose: To educate students of appropriate diagnosis and treatment of pediatric dysphagia.

Learning Outcomes:

1)     Differentiate between typical and atypical anatomy and physiology in the area of pediatric dysphagia.

2)     Communicate appropriate treatment plans for atypical anatomy, physiology, and feeding behaviors.

3)     Prepare liquids and solids at all levels of the International Dysphagia Diet Standardization Initiative (IDDSI).

4)     Execute Cervical Auscultation.

5)     Interpret a typical and atypical Videofluoroscopy Swallow Study (VFSS).

6)     Communicate professionally and effectively to develop a comprehensive pediatric feeding evaluation.

Unit 1: Introduction and Anatomy/Physiology

-Survey: Personal experiences with pediatric dysphagia, Learning style inventory

-Think-Pair-Share (TPS): What do you know about pediatric dysphagia?

     - Identify what you already know about pediatric dysphagia with a partner (no matter how big or small it may seem).  If you don’t think you know anything, that’s okay too. Share with your partner. List what both of you know. Share with the whole group.

-Anatomy & Physiology

     -Lecture with open discussion regarding pictures/diagrams and videos of typical anatomy and physiology. Discuss the function of typical anatomy.

     -Phases of swallow: Lecture with visuals

-Assessment: Summative: Labeling targeted anatomy, describing physiology/function as it relates to feeding and swallowing, describing the phases of swallowing.

-Reflection of Unit 1

Unit 2: Atypical Anatomy & Physiology

-Atypical Anatomy & Physiology

     -Delayed feeding skills, delayed development, premature infants/toddlers, structural abnormalities/cleft lip and palate, aspiration (more to come on aspiration).

-Lecture/Presentation/Videos of atypical anatomy & physiology + What treatment looks like for these.

     -What atypical lip movements look like + TPS regarding possible treatment/feedback

     -What atypical usage of teeth looks like + TPS regarding possible treatment/feedback

     -What atypical usage of tongue looks like + TPS regarding possible treatment/feedback

     -What atypical usage of cheeks look like + TPS regarding possible treatment/feedback

     -Atypical bottle feedings + Discussion regarding possible treatment/feedback

-Assessment: Formative: Completed in the form of the above TPS, partners will discuss and write the identified atypical anatomy and/or physiology and possible treatments after watching recordings of atypical anatomy and physiology.

-Reflection of Unit 2

                                                      Unit 3: Atypical Behaviors

-Lecture/Presentation/Videos of atypical behaviors + What treatment looks like for these.

     -Overstuffing food in mouth + TPS regarding possible treatment/feedback

     -Holding food in mouth + TPS regarding possible treatment/feedback

     -Food falling out of mouth while chewing + TPS regarding possible treatment/feedback

     -Not clearing bolus during a swallow + TPS regarding possible treatment/feedback

     -Milk leaking during bottle feeding + Discussion regarding possible treatment/feedback

     -How are oral motor skills involved with these behaviors? (whole group discussion)

Assessment: Formative: Completed in the form of TPS, students will write key points of their discussion to include the identified atypical behavior and possible treatment after watching video recordings of atypical feeding behaviors.

-Reflection of Unit 3.

Unit 4: Aspiration

-Lecture with videofluoroscopy swallow study (VFSS)images of normal swallow, penetration, aspiration, and silent aspiration. Brief description of aspiration vs. choking. Questions/Feedback

-VFSS

     -Videos + TPS + Feedback

     -Videos + Whole group discussion + Feedback

     -Videos: Summative Assessment: Students will watch 3 recorded VFSS and write their interpretation of the swallow study (normal swallow, penetration, or aspiration).  

-Experiential Learning with Cervical Auscultation

     -Thin liquid

     -Solid food

     -Suck-Swallow-Breath Pattern

     -Formative Assessment of Cervical Auscultation: Using stethoscopes, students will perform Cervical Auscultation on a peer along with the instructor (simultaneously) and discuss findings. This will be completed as many times as needed by the student until students’ findings are equivalent to the instructor’s.

-Experiential Learning of the International Dysphagia Diet Standardization Initiative (the IDDSI) + Feedback

-Formative Assessment: Demonstration of the ability to prepare food and liquids at all levels of the IDDSI in the presence of the instructor. The IDDSI handout guide is allowed to be used during this assessment.

Reflection of Unit 4

Unit 5: Pediatric Feeding Evaluation

-Lecture with whole group discussion regarding pediatric feeding evaluation.

     -Students will watch a video of the teacher performing a feeding evaluation. Thought provoking questions and discussion to occur throughout and after the video. Discussion and feedback.

     -TPS + Reflection: Given “intake information,” develop/outline/plan your own feeding evaluation and include tools needed for eval (ex. Honey Bear cup, E-Z Spoon, Maroon Spoon, etc). Join partner and compare plans. What do you like about your partner’s plan? What do you like about your plan? Would you change anything? If so, what would you change?  (This is verbal and written and will be turned in as a Summative Assessment.)

Feeding Evaluation Write-up: How to capture all of this information in an evaluation report.

     -Lecture with examples of evaluation reports.

     -Formative Evaluation: Students re-watch recording of the instructor performing a feeding evaluation and be given all data/results from evaluation. Students will write pediatric feeding evaluation report based off viewing of recording and written data/results. Students may submit their evaluation report to the teacher one time for correction recommendations before submitting the final report.

-Reflection of Unit 5

Course Wrap-Up

-What do you know about pediatric dysphagia now? List 5 things you know now that you didn’t at the beginning of this course.

-Reflection of course (What did you enjoy? What was difficult? Is anything still unclear? Questions? Feedback).

-Instructor Evaluation

Adult Dysphagia

Course Purpose: To educate students of appropriate diagnosis and treatment of adult dysphagia.

Learning Outcomes:

1)     Differentiate between typical and atypical anatomy and physiology in the area of adult dysphagia.

2)     Communicate appropriate treatment plans for atypical anatomy, physiology, and feeding behaviors.

3)     Differentiate between pediatric and adult dysphagia.

4)     Interpret a typical and atypical Videofluoroscopy Swallow Study (VFSS) and make appropriate recommendations.

5)     Communicate professionally and effectively to develop a comprehensive adult bedside feeding evaluation.

Unit 1: Introduction and Anatomy/Physiology

-Survey: Personal experiences with adult dysphagia, Learning style inventory

-Whole group discussion: What do you know about adult dysphagia?

     - As a whole group, identify student experiences with adult dysphagia.  

-Anatomy & Physiology

     -Lecture with open discussion regarding pictures/diagrams and recordings of typical anatomy and physiology. Review the function of typical anatomy and phases of swallow.

     -Identify how these differ from pediatrics

-Assessment: Summative: Labeling targeted anatomy, describing physiology/function as it relates to feeding and swallowing in adults.

-Reflection of Unit 1

Unit 2: Atypical Anatomy & Physiology

-Atypical Anatomy & Physiology/Causes

     -Causes: Cerebrovascular Accident (CVA, stroke), Traumatic Brain Injury (TBI), Neurodegenerative Diseases, Acid Reflux, Esophageal Spasms, Aspiration  

-Lecture/Presentation/Videos of atypical anatomy & physiology + What treatment looks like for these.

     -What atypical lip movements look like + TPS regarding possible treatment/dietary recommendation + feedback

     -What atypical usage of teeth/dentures (or no teeth) looks like + TPS regarding possible treatment/dietary recommendation + feedback

     -What atypical usage of tongue looks like + TPS regarding possible treatment/dietary recommendation + feedback

     -What atypical usage of cheeks look like + TPS regarding possible treatment/dietary recommendation + feedback

-Assessment: Formative: Completed in the form of the above TPS, partners will discuss and write the identified atypical anatomy and/or physiology and possible treatment/dietary recommendation after watching recordings of atypical anatomy and physiology in adults. Include one difference from pediatrics.

-Reflection of Unit 2

                                                      Unit 3: Atypical Behaviors

-Lecture/Presentation/Videos of atypical behaviors + What treatment looks like for these.

     -Overstuffing food in mouth + TPS regarding possible treatment and/or IDDSI diet + feedback

     -Holding food in mouth + TPS regarding possible treatment and/or IDDSI diet +feedback

     -Food falling out of mouth while chewing + TPS regarding possible treatment and/or IDDSI diet + feedback

     -Not clearing bolus during a swallow + TPS regarding possible treatment and/or IDDSI diet + feedback

     -Pocketing food in buccal cavity + Whole Group Discussion regarding possible treatment and/or IDDSI diet + feedback

     -Delayed swallow + Whole Group Discussion regarding possible treatment and/or IDDSI diet + feedback

Assessment: Formative: Completed in the form of TPS, students will write key points of their discussion to include the identified atypical behavior and possible treatment and/or IDDSI dietary recommendation after watching recordings of atypical feeding behaviors in adults. List at least one difference from pediatrics.

-Reflection of Unit 3.

Unit 4: Aspiration

-Lecture with videofluoroscopy swallow study (VFSS) images of normal swallow, penetration, aspiration, and silent aspiration. Questions/Feedback

-VFSS

     -Videos + TPS to include recommendation of IDDSI diet if appropriate + Feedback

     -Videos + Whole group discussion to include recommendation of IDDSI diet if appropriate + Feedback

     -Project: Schedule to observe 3 VFSSs at local hospital. Write your interpretations of the swallow studies to include treatment and/or IDDSI dietary recommendations if appropriate. Then, write up a comparison of your interpretations/recommendations and the evaluating SLP’s interpretation/recommendation. Also include the amount of time (use a timer/watch) each VFSS took along with how many swallows were included in the swallow study. 

     -Videos: Summative Assessment: Students will watch 3 recorded VFSS (1 viewing of each recording) and write their interpretation of the swallow study (normal swallow, penetration, or aspiration) as well as treatment and IDDSI dietary recommendations. Students will have 5 minutes to write up interpretation and treatment/recommendations. Include at least one difference from pediatrics.

Reflection of Unit 4

Unit 5: Adult Bedside Feeding Evaluation

-Lecture with whole group discussion regarding adult bedside feeding evaluation.

     -Students will watch a video of an SLP performing a bedside feeding evaluation. Thought provoking questions and discussion to occur throughout and after the video. Discussion and feedback.

     -TPS + Reflection: Given “intake information,” develop/outline/plan in no longer than 3 minutes your own bedside evaluation. Join partner and compare plans. Would you change anything? If so, what would you change?

     -Bedside feeding evaluation on a peer: Given 2 minutes to prepare, complete a bedside feeding evaluation on a peer lasting no longer than 4 minutes. Write interpretation in 2 minutes. Also write how you felt (ex. rushed, nervous, calm, competent). This will be written professionally and turned in as a formative assessment.

     -Summative Evaluation: Students will watch recording (1 viewing) of the instructor performing a bedside feeding evaluation and be given all notes (data/results) from evaluation. Students will write interpretation and treatment recommendations based on viewing of recording and written notes within 2 minutes. Include one difference from pediatrics.

-Reflection of Unit 5

Course Wrap-Up

-TPS: List 5 differences between adult dysphagia and pediatric dysphagia. What do you find challenging about adult dysphagia?

-Reflection of course (What did you enjoy? What was difficult? Is anything still unclear? Questions? Feedback).

-Instructor Evaluation