Dysphagia Ramblings

BOLUS Framework Quick Guide A Practical Dysphagia Reference for SLPs The BOLUS framework helps clinicians think beyond aspiration alone when evaluating the risk of an adverse event in patients with dysphagia. Aspiration does not automatically lead to aspiration pneumonia or pulmonary complications. Risk is influenced by the aspirated material, the patient’s host defenses, overall health, oral…

Feeding Tubes: What They Are (and What They Are Not) Few topics in dysphagia management stir up as much emotion, confusion, and clinical debate as feeding tubes. For patients and families, the idea of a feeding tube can feel overwhelming. For clinicians, especially SLPs, the recommendation process can feel ethically and professionally complex. One thing is clear: feeding tubes should never be…

When most clinicians hear LSVT LOUD, they think: voice, loudness, Parkinson’s, intensity, calibration. But here’s the interesting part… Swallowing and voice share real estate. Same neighborhood. Same structures. Same airway. So it shouldn’t be surprising that an intervention designed to improve respiratory effort, vocal fold adduction, and neuromuscular control of the upper aerodigestive…

If you’ve worked in dysphagia long enough, you’ve probably heard it too. “I just want some water.” “My mouth is so dry.“ “The thickened drinks just don’t hit the same.” They just want water—cold, clear, simple water. I can’t count the number of patients who have said that to me over the years. Patients who are NPO. Patients on thickened liquids. Patients who haven’t had a sip of plain water…

When we talk about dysphagia, so much of our clinical attention gravitates toward airway protection, aspiration pneumonia, what exercises to give, and diet textures. But one area that consistently flies under the radar—and directly affects patient outcomes—is hydration. Dehydration is common in individuals with dysphagia. When liquids are thickened, restricted, or avoided, patients often…

Introduction In swallowing rehabilitation, one of the most debated questions is: Should we train skill or strength? At an ASHA Convention several years ago, this debate highlighted the question of whether dysphagia therapy should primarily target muscle strength or motor skill learning. Since then, growing evidence suggests that the answer is not either/or—it’s both. In this post, I’ll break…

Dysphagia after head and neck cancer treatment is one of the most challenging complications we face as clinicians. Despite best efforts at prevention, many patients continue to develop moderate to severe swallowing difficulties following radiation or surgery. At MD Anderson Cancer Center, the Dysphagia Boot Camp was launched in 2012 to standardize an intensive, multidisciplinary approach to…

We’ve all been there. You start a new job, and the first thing they tell you is when to show up in the dining room so you can “do therapy during meals.” Easy, right? You sit with 8 patients, remind Mr. A to use a chin tuck, and politely ask Mrs. B to slow down between bites. Except that’s not therapy. That’s supervision with a side of coffee refills—and no tips. From Waitress to Rehab…

When it comes to instrumental swallowing assessments, FEES (Flexible Endoscopic Evaluation of Swallowing) has spent years in the shadow of its more established cousin, the Modified Barium Swallow Study (MBSS). But let’s be real—it’s time to stop treating FEES like the red-headed stepchild of the dysphagia world. Let’s dive into what FEES really is, how it has evolved, and bust a few myths along…

MBSS vs. FEES: It’s Not a War, It’s a Team Effort Let’s just say it: the dysphagia world has become divided. Team MBSS on one side. Team FEES on the other. Social media might make it feel like you have to pick a side—ride or die with fluoroscopy or scope it till you choke it (just kidding… kinda). But what if we didn’t have to choose? What If… It’s Not MBSS vs. FEES, But MBSS AND FEES? The…

A Guide to Macronutrients, Micronutrients, and Boosting Nutritional Intake 1. What Is Nutrition? Nutrition is the process by which our bodies take in and use food substances to support growth, repair tissues, maintain organ function, and provide energy. For patients with dysphagia or those requiring texture-modified diets, ensuring adequate nutrition becomes more challenging—but also more…

If you haven’t heard, Simply Thick is at it again. This time, they have published a cook book with dysphagia-friendly recipes. I was really excited to get this book in my hands. I wasn’t sure what to expect at first, however this cookbook is amazing!! The cookbook contain IDDSI compliant recipes for levels 4, 5 and 6. What I love the most about this cook book is that the recipes are simple.…

Once upon a time, I worked in a setting and had to send my patients out for the MBSS. Now, I am able to complete my own MBSS. One thing I take into account when I am doing an MBSS for another SLP is making sure they get a complete study. I have actually gone to several CE courses regarding MBSS in the last 2 years. When I say a complete MBSS, I don’t mean that I test 15 different foods using…

No matter what you call it…there is a history behind the Modified Barium Swallow Study (MBSS). Gold Standard? The Modified Barium Swallow Study has long been called THE gold standard in dysphagia evaluation, however it does have its limitations.   The MBSS definitely continues to be A gold standard in swallowing evaluation. Early Days In the 1970’s, Dr. Jeri Logemann developed the MBSS or the…