SPHY603 - Advanced Speech Pathology Practice 1 Optimising Swallowing Function

Year

Credit points

Campus offering

Prerequisites

SPHY612 Enhancing Clinical Reasoning in Rehabilitation for Speech Pathologists AND HLSC630 Holistic Rehabilitation and Restoration 1

Teaching organisation

Unit rationale, description and aim

The ability to comprehensively assess and manage swallowing disorders is an essential aspect of clinical practice for speech pathologists working with aging clients and clients with a range of neurological impairments. SPHY603 offers post graduate speech pathology students the opportunity to update and enhance theoretical knowledge and clinical skills. Advanced use, and interpretation of, clinical and instrumental assessments will form the basis for planning holistic management and care with application of the best available evidence under the ICF Framework. Advanced practice in tracheostomy assessment, including interpretation of instrumental assessment and evidence based management protocols will be presented. This unit aims to encourage students to further develop and apply to their practice, their enhanced knowledge and skills associated with critical analysis of swallowing, goal setting, and collaborative person-centred application of evidence based techniques required to optimally manage swallowing disorders.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Integrate, apply and critically discuss enhanced knowledge of anatomy, physiology and the neurological control of the normal swallowing process across the lifespan to differentiate age-related and disordered swallowing including the impact of a range of neurological lesions and structural abnormalities on the swallowing process (GA3, GA4, GA5) 

LO2 - Administer, and critically analyse comprehensive clinical and instrumental assessments of swallowing function to inform holistic care plans that address client-led needs and goals aimed at maximizing outcomes and participation (GA3, GA4, GA5, GA7, GA8,) 

LO3 - Demonstrate advanced ability to develop, apply, communicate, critically review and justify an evidenced-based treatment program for swallowing disorders designed to promote optimal outcomes for clients across the lifespan and with neurological disorders incorporating the roles of medical specialist (neurologists, ENT specialists, gastroenterologists) (GA3 GA4 GA5; GA7; GA8 GA9); 

LO4 - Critically discuss the ethical and medico-legal issues facing clinicians in the area of dysphagia practice, including the speech pathology role in care of the individual with palliative care needs (GA1, GA3, GA5) 

LO5 - Reflect on application of knowledge, skills and experiential learning in the clinical setting and analyse the implications for the assessment and interventions for optimal development of swallowing rehabilitation for clients across the lifespan and with neurological disorders, as well as for your personal and professional growth as a speech pathologist (GA3, GA4, GA5,GA7, GA8, GA9) 

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity 

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

Content

Topics will include: 

Critical review of knowledge and skills - swallowing 

• Review of anatomy, physiology and neurological control of the normal swallow across the lifespan 
• Review of age related changes commonly seen in swallowing  
• Frailty, swallowing and nutrition 
• Ethical and medico legal issues in dysphagia  
• Critical review of the clinical assessment and its adjuncts – analysing the evidence 
• Advanced differential diagnosis in dysphagia presentation – underlying neurological and structural considerations 
• Practical skill development session – differential diagnosis and clinical assessment; ethical and medico legal considerations 

Dysphagia 1 

• Assessment of dysphagia 1 
• Videofluoroscopy – strengths and limitations – analysing the evidence  
• Practical  
• Videofluoroscopy – practical and logistical considerations in undertaking assessment  
• Videofluoroscopy – advanced interpretation considerations and practice 

Dysphagia 2 

• Assessment of dysphagia 2  
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) - strengths and limitations – analysing the evidence 
• FEES – an introduction to practice and practice considerations   
• Practical  
• FEES – practical and logistical considerations in undertaking assessment  
• FEES – advanced interpretation considerations  

Patient management planning 

Integrate assessment findings by integrating the clinical and VF and FEES examinations  

Interpretation of results and selection of goals  

Involvement of other health professionals 

Treatment approaches – direct and indirect – analysing the evidence 

Advanced case studies – applying the evidence 

Complex patient management issues 

• Beyond acute care: tracheostomy in neurological or aged populations 
• Understanding indications for intubation and mechanical ventilation in this population 
• Understanding indications for extubation in the neurological and aged populations 
• Indicators for tracheostomy in the neurological or aged population  
• Ventilation types, indications and implications for communication and swallowing 
• Specialist areas in tracheostomy management (e.g. slow to wean, burns, TBI) 
• Understanding assessment and management of swallowing and communication for individuals with tracheostomy: evidence based practice 
• Complexities of management in this client group and a critique of the evidence 

Palliative care and speech pathology across the continuum of care 

• Review of the speech pathology role across the continuum considering diversity / socio-economic / cognitive and behavioural issues  
• Understanding the role of palliative care and approaches to management  
• Functional decline and end of life considerations 
• Speech pathology and palliative care 
• Swallowing issues: clinical, ethical and medico legal considerations  
• Communication issues: clinical, ethical and medico legal considerations 
• Managing the challenges associated with end of life care 

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for specific on and offshore cohorts. Both modes aims to facilitate learner centred activities and workplace learning. Learning and teaching strategies within this Graduate Diploma level unit are based on a blend of constructivism, social constructivism, and experiential learning. These strategies focus on active participation and developing a community of inquiry. Purposefully designed content and activities that are the same or similar for all participants regardless of the mode of delivery have been identified. This has led to the development of purposefully designed learning activities that are transferable and work well across both delivery mediums whilst maintaining the flexibility to create and deliver mode specific activities focusing on inquiry based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning, and critical self-reflection.  

In addition, students participate in individual and small group activities based on analysis of current practice, to assimilate application of enhanced knowledge and facilitate translation of learning into practice. Engagement in extended dialogue is encouraged to guide change to a more interprofessional, person-centred practice. Unit activities include, but are not limited to: guided readings, synchronous on-line tutorials, work-based activities with reflection, use of a reflective journal during experiential learning, skill development, and mentoring to enhance practice. To facilitate practical application of knowledge and skills, multi-mode delivery requires participation in a required mid unit intensive practical workshop. Where possible, workshop activities are designed as reusable learning objects able to be provided online or modified slightly as required for current information and communication technologies for online delivery. As required, for example in different time zones learning and teaching strategies will be adapted for online delivery for specific cohorts. Activities undertaken in both modes are aimed to facilitate acquisition of advanced knowledge and skills in collaborative and assessment and intervention planning strategies. Post workshop workplace activities are supported through a clinical visit and/or use of information and communication technologies. 

Assessment strategy and rationale

SPHY603 assessments have been purposefully designed to replicate authentic clinical practice. Significantly, the unit’s assessments have also been designed from an “Assessment for Learning” approach in order to not only provide evidence for judgement of learning, but also to reinforce, facilitate and support learning and application of learning. The assessment tools have been designed to provide for a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the post graduate student. The design enables timely judgement to ensure students have appropriate knowledge and skills prior to the workplace application segment of the unit. In addition, the range of assessment activities at the end of the unit encourage application of evidence to practice and embed clinical reasoning, problem solving and implementation of advanced knowledge and skills.   

The first assessment task provides students with the opportunity to demonstrate advanced and critical analysis of a case study and to identify and apply optimal evidence based interventions. The focus of the final two assessment items, is to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. In the second assessment task students will identify an evidence based intervention for implementation in their work setting. Students will outline the evidence gap, appraise the relevant evidence and apply to their work setting, and communicate the implementation plan for this evidence practice gap within their work setting. Assessment task 3 enables students to demonstrate the application of advanced skills in the delivery on an evidence based intervention with a client, their clinical reasoning and clinical decision making.  

In addition to assessing enhanced clinical skills, a major focus of the final two assessment items, is the ability to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. These assessments incorporate the advanced level of professional knowledge and skills, enhanced critical analysis and professional presentation modes developed throughout the post graduate program.  Scheduling of assessments will be equitable for both modes of delivery. Assessment tasks may be delivered and assessed locally with moderated according to University Policies and Procedures. All assessments will be submitted electronically. 

Overview of assessments

Representative texts and references

Daniels SK, Huckabee ML. (2014) Dysphagia following strok2 (2nd ed). Clinical dysphagia series. Sand Diego, California: Plural Publishing https://ebookcentral.proquest.com/lib/acu/detail.action?docID=1886731 

Humbert, IA, McLaren, DG, Kosmatka, K, Fitzgerald, M, Johnson, S, Porcaro, E, Kays, S, Umoh, EO, & Robbins, J (2010). Early deficits in cortical control of swallowing in Alzheimer’s disease. Journal of Alzheimer’s Disease, 19(4), 1185-97.  

Jones, H & Rosenbek, J (2009). Dysphagia in rare conditions. San Diego, CA: Plural Publishing. 

Lazaridis, C, DeSantis, S, McLawhorn, M, & Krishna, V (2012). Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care. Journal of Critical Care, 27(4). 417.  

Leonard, R & Kendall, K (2014). Dysphagia Assessment and Treatment: A Team Approach (3rd ed). Plural Publishing: San Diego. 616.323 DYS 

Malandraki, GA, & Robbins, J (2013). Effects of aging on oral contributions to deglutition. In R. Shaker, G. Postma, P. Belafsky, & C. Easterling (Eds). Principles of Deglutition: A Multidisciplinary Text for Swallowing and its Disorders. New York: Springer. 

Malandraki, G. & Robbins, J (2011). Dysphagia Neurorehabilitation. In M.J. Aminoff , F. Boller, D.F. Swaab (Eds.), Handbook of Clinical Neurology series, 3rd ed.  

Mascia, L, Corno, E, Terragni, P, Stather, D, & Ferguson, N (2004). Pro/con clinical debate: Tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment. Critical Care, 8(5): 327-330.  

Miller, R & Britton, D (2011). Dysphagia in neuromuscular diseases. San Diego, CA; Plural Publishing.  

Saitoh E (Ed) (2018) Dysphagia evaluation and treatment: from the perspective of rehabilitation medicine. Singapore: Springer.