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Dysphagia and telepractice during COVID-19 and beyond - Shared screen with speaker view
SUZANNE MOINEAU
01:20:23
Can people mute their mics?
Simón David Vargas Pérez
01:20:38
Please
Sany Naiim
01:20:39
Done
Rasangi
01:20:52
Done
Deborah Lanza
01:20:55
can everyone mute their mic
Bette Siler
01:21:06
Please MUTE your mike
Lymarie Ortiz
01:21:22
Please MUTE the mics
Darleen M Molina Toledo
01:21:33
leyda mute your 🎤
Virginia Cooper
01:21:49
can you mute everyone?
Macarena Martínez
01:22:00
Please mute participants
Jenna Milburn
01:22:09
admin should be able to mute everyone except the speaker
Courtney Brimm
01:22:14
PLEASE!
Leslynette Ramos-Irizarry
01:22:24
Please mute all. Thanks :)
Deborah Lanza
01:22:47
Why is someone not taking care of this!!!
Karen Floriano-Heimerl
01:23:37
Thank you for offering this. Will this be offered to watch as a recording? I am not able to listen for the 2 hour duration. Thank you.
Georgia Malandraki
01:24:00
Yes
Karen Floriano-Heimerl
01:24:29
Thank you.
Carolyn Perry
01:25:12
Howdy from Texas and I am excited to hear the presenters!!!!!
Quira Rodgers
01:36:25
Does a facilitator need any special credentials? Can it be a family member? CNA?
Una Moynihan
01:40:02
can you give a little more detail about the role of the facilitator. Can you give me a an example of who selects the facilitator?
Danila McAsey
01:41:10
Do you provide a checklist for the patient or caregiver with respect to logistics and equipment?
Michele Simler
01:41:59
Do you follow a specific protocol for the evaluation - such as using the MASA?
jo puntil
01:44:47
Great job you guys! Wonderful “seeing” you!
Lymarie Ortiz
01:45:26
Any specific recommendations for the oral peripheral exam in pediatrics via Telepractice?
Alhanouf Alaskar
01:45:39
is there a national consent form for the teletherapy
Alhanouf Alaskar
01:45:43
?
Jenna Milburn
01:46:25
Torch is the same as flashlight?
Darren Wiebe
01:46:31
Would you be able to share with us your templates that you use to prepare the clients and facilitators for the sessions/assessment
Miossottys Plaza
01:46:46
Will we be getting your web guide?
Georgia Malandraki
01:47:08
Yes - all our resources will be shared!
Kathryn Morrell
01:47:25
Thank you!
Miossottys Plaza
01:47:30
Excellent thank you!
Alhanouf Alaskar
01:47:39
Great, Thank you
Darren Wiebe
01:48:06
thank you very much
Akila Rajappa
01:50:27
So excited to see you all! Amazing discussions. Thank you so much, Dr. Malandraki, Dr. Ward and Dr. Burns!
Clare Burns
01:50:53
Yes - all the learning programs are accessible at the end of this webinar
Kathryn Morrell
01:51:17
Also we need to check our licensing laws for consent rules and emergency procedure rules.
Kathryn Morrell
01:51:37
State licensing laws.
Jasmine Lydia Selvaraj
01:54:58
I am Jasmine Lydia from India. I am glad to write to you. what are various “needs assessment” for tele-practices and is there any special considerations/ adoption for developing countries.
jo puntil
01:56:05
Will you address if clinicians can do a session with a patient, could it be recorded with patient permission of course, for students to learn? Seeing that students are now not in clinics/hospitals etc, could these sessions be recorded for “simulation” cases?
Jenna Milburn
01:56:47
Does the facilitator need to be CPR or BLS certified?
Bella Panchal
02:03:37
Can you mute people that are not speakers please
Carolyn Perry
02:04:37
such a good point!!!
Sany Naiim
02:04:40
Hi, I am Sany From QatarI am so glad to join youIs it better to have a preparation session or orientation with the facilitator to explain the procedure exactly before the actual procedure ?
Alhanouf Alaskar
02:06:16
what about if it was a silent aspiration with no signs ?
Alhanouf Alaskar
02:06:44
and how to assess hyolaryngeal movement ?
Carolyn Perry
02:06:47
clinical eval will not help there; need instrumental
Sri Nandamudi
02:08:19
Have you evaluated someone who is on supplemental O2? If yes, do you take help of facilitator to take vitals etc.?
Arwa Bin salamh
02:09:28
how can i be sure of the consistency used by the patient during tele-practice?
Kathryn Morrell
02:10:16
If you can get things pre-packaged so no mixing is required, that is the most accurate.
Jenna Pellegrini
02:11:25
Certain technology is not available right now because it is sold out. What does this mean for us, if we can't access a mobile webcam? Would we then be required to schedule face to face and then have to figure out PPE, refer to other facility? Or are there some technology work-arounds if the ideal equipment is not available?
Isabel Robles
02:12:10
Have we seen different swallowing issues with Covid-19 compared to the dysphasia issues that we normally encounter?
Alhanouf Alaskar
02:12:41
so how I check the hyolaryngeal elevation ?
Rosemary Griffin
02:12:58
Would be helpful to know if presenters entered into telehealth due to geographical restrictions rather than pandemic. What proportion of their patients convert from clinical swallowing evaluations to objective assessment (MBSS)?
Kathryn Morrell
02:13:03
@Arawa Bin salamh: are you doing IDDSI testing?
Jenna Pellegrini
02:13:04
yes please.....how do you do an oral mechanism exam!!!
Alhanouf Alaskar
02:15:14
Great, thank you
Jenna Pellegrini
02:15:23
to get a sense of lingual strength, I was thinking about making a rough judgment about how far they can push out their cheek with their tongue. We can't really use the facilitator to make a call about how much the patient's tongue resists pushing by tongue depressor......
Alhanouf Alaskar
02:17:19
Agree!
Athena Alvarado
02:17:56
EAT 10 is a great questionnaire
Rasangi
02:17:57
How would you adapt cervical auscultation during swallowing Ax?
Athena Alvarado
02:19:14
cam facilitator is a tongue strengthening measuring device to get an objective measurement?
Athena Alvarado
02:19:18
can
Arwa Bin salamh
02:19:31
No actually i assess it subjectively
Sri Nandamudi
02:20:31
thank you for answering the question on monitoring respiratory status as part of evaluation. How about cognitive status? How much would you consider this to continue with rest of the steps of CBSSE? and treatment plan? Assuming they might not assistance of facilitator all the time...
Paula Stone
02:20:49
Thank you for presenting this alternative option of telepractice and dysphagia as we provide service access for dysphagia patients.
Ann Marie Arena
02:21:23
What do you use for sensory measures for taste?
Rosemary Griffin
02:21:49
Any lessons learned for situations where you might have underestimated a clinical concern. Given your number of years doing this, what have you learned?
Lymarie Ortiz
02:22:56
Any specific online approved questionnaire or assessment that you can recommend?
Sierra Downs
02:23:41
Yes! Thank you, Dr. Malandraki. Just fyi - if you have permission to adapt questionnaires as appropriate, JotForm is offering free hippa compliant accounts with an npi number
Shobha Sharma
02:24:52
Hi everyone. In Malaysia, I have had to use the mobile phone to do a session for a patient who had pulled out his feeding tube during the Covid lockdown. Family insisted he could feed orally but clearly the tele CSE found otherwise. So we have to innovate when equipment is not ideal!
Kathryn Morrell
02:26:37
Great job, Shobhaa Sharma!
Ilana Bortinger
02:27:43
Hi I was unable to join earlier. Will the recording be available for later viewing? Thanks!
Monica Sampson
02:28:55
yes - it will be available on the ASHA website.
Loreen Blumenthal
02:31:27
Do you ever send thickener packets to patients before the evaluation to use during the assessment as needed?
Tahereh Mohammadi
02:31:51
Hi Dr Malandraki, in patients who have lost their sensation after COVID what would be the best treatment and since the patients are in bad psychology situation, is it necessary for us to have intervention in this case and if yes how we can do it ?
Jenna Pellegrini
02:32:03
that's what I was planning to do. And a syringe for IDDSI flow test
Loreen Blumenthal
02:33:35
If the patient demonstrates signs and symptoms of aspiration during the CDE and no diet consistency can be recommended do. you typically suggest NPO or have a quality of life conversation with the pt/family pending an instrumental examination which may take a bit of time to get scheduled.
Carolyn Perry
02:34:03
I very much appreciate that the speakers are sharing that so much of what we are doing in rural or underdeveloped settings is "the best we can" and not for research!
Jan Snavely
02:35:22
agreed, evidenced based is fine for some arenas and then there is providing resources, immediate support and caregiver education which is invaluable to family
Carolyn Perry
02:36:27
I also appreciate that it is person centered care based in the home environment with the tools/resources that are available in the home!
Tahereh Mohammadi
02:36:39
Thank you for your information
Alhanouf Alaskar
02:36:43
sorry for going back to the assessment part, but what about if the pt needed an innstrumental tool for example MBSS ?
Sri Nandamudi
02:37:05
-how about pharyngeal resistance exercises? thermal stimulation? how about co-treating with PT or OT in terms of assessing positioning/posture and feeding adaptive devices via telepractice? Thank you!
Rasangi
02:37:26
typically what's the duration of a telehealth swallow session?
Jenna Pellegrini
02:40:59
Thank you Dr. Malandraki, this is an important point!!!!
Jenna Pellegrini
02:41:46
then what options do we have? Seeing them in person and have to figure out PPE....refer elsewhere?
Jenna Pellegrini
02:42:37
As a private practitioner, access to PPE isn't really possible...so I guess I would refer someplace where they have access to PPE??
Jan Snavely
02:43:16
What about application to snf and you are not in the same facility
jo puntil
02:43:18
Amen Dr. Malandraki!!
Carolyn Perry
02:45:17
I've heard (ASHA webinar last week) that facilities are "going blind" without any instrumental assessment availability due to it being an AGP (Aerosol Generating Procedure) and considered too risky. Has that lightened up any?
Quira Rodgers
02:46:13
Great question Carolyn! At the SNF level we have limited/no access to instrumentals with all this…really really tough to navigate
Madhura Bhalerao
02:48:28
Is there any way to assess muscle tone in pediatric population during telepractice?
Jenna Pellegrini
02:49:19
CSE is AGP as well. In private practice, my plan is to do the CSE, give diet recommendations (because frankly, if we can keep patients safe and out of the hospital, we should), hydration & oral care concerns, brief follow-up plan for tolerance and understanding, and holding off on therapy until instrumental assessments are available again.
Amy Lustig
02:49:58
Best recommendations for communicating evaluation results to other medical providers, especially if referrals and/or additional testing is recommended?
Indira Feustel
02:50:23
Michael Shumacher?
Simón Vargas
02:50:43
Yes, we know him very well
Simón Vargas
02:50:51
A F1 racer
Simón Vargas
02:51:08
From Germany
Simón Vargas
02:51:24
Regards from Colombia
Carolyn Perry
02:51:45
to Jenna Pellegrini- agree re AGP aspect. But the limitation of NO follow up with instrumental assessment has been worrisome to many
Simón Vargas
02:52:29
Thank you very much for this information about telepractice
Carolyn Perry
02:53:29
Tele IPE!!!! Love it
Michele Simler
02:53:32
Agree - this is a specific skill providing telehealth! Also the rules for student and using telehealth vary by state to state
Jan Snavely
02:54:08
agreed to many telerx is simply anotg
Jan Snavely
02:54:23
another venue for service delivery-
Carolyn Perry
02:55:08
We use IPE very much but will be adding tele IPE component!
jo puntil
02:55:49
PLEASE!! Amen Dr. Malandraki
Carolyn Perry
02:56:09
thank you for considering students and their needs!!!!! WE ARE REALLY in a BIND prior to COVID_-19!!!!!
jo puntil
02:56:24
We need more session recorded from experienced SLP’s! Would love to see some with H&N CA pts, etc.
Danieska Giron-Querales
02:57:24
Are graduate students able to observe only through telepractice and/or are we able to provide intervention with appropriate supervision?
Jenna Pellegrini
02:57:34
YES! I second that! Having a visual of how to apply everything! I had to laugh at myself trying to get acoustic data via telehealth...wish I had seen an experienced telehealther do it first!
Danieska Giron-Querales
02:57:56
there are states that do not have an actual regulation/law in regard to telepractice and graduate student clinicians
Carolyn Perry
02:58:12
students can provide therapy in some states. multiple students (2-3) can count but must have 100% supervision
Phyllis Palmer
02:59:14
CFCC is supporting telehealth sessions for clinical clock hours , and the supervisor does not need to be in the same room as the student clinician. So call your local University or your alma mater and offer to help get students their clock hours.
Carolyn Perry
02:59:44
yes Phyllis!!!!!!
Elizabeth Ward
03:00:34
absolutely - such at great way to train the students, get clock hours and support patient care
Michele Simler
03:00:43
True Phyllis, but states do vary on the supervision rules
Carolyn Perry
03:01:11
national standard is 100% supervision to count for contact hours for students
Valeria Caraballo
03:01:30
any Feeding Therapy by Telepractice courses
jo puntil
03:01:39
And we get to see “experts” or advanced experienced people in our field do great work, what a wonderful way for students and newer clinicians to learn…please record you guys, we need to “see” you in action.
Michele Simler
03:02:03
Amen!! Georgia we need the allowance to be permanent
Indira Feustel
03:02:17
Thank you so much!
Terri Mogilefsky-Raymont
03:02:20
thank you all, excellent presentation.
Debbie Yaker Spellman
03:02:30
Amen… Permanent.. and Hybrid approach when needed..
jo puntil
03:02:34
EXCELLENT work, thank you so much!!
Alhanouf Alaskar
03:02:35
where can we find the recourses you have mentioned :)
Erin Cunningham
03:02:38
Thank you all! Wonderful presentation!
Gina Gallo
03:02:39
Thank you all so much. This was fabulous!
Carolyn Perry
03:02:46
wonderful information! you have given me much to think about for student preparation!!!!!!
Michele Simler
03:02:46
Thank you - great presentation!
Jan Snavely
03:02:47
Thank you very much-so exciting to have
Rasangi
03:02:49
Thank you very very much!! This was beyond excellent!!
Macarena Martínez
03:02:50
Thank you very much
Quira Rodgers
03:02:54
Yes, THANK YOU!! This was wonderful information
Jenna Pellegrini
03:02:56
Thank you! You've given me the courage to get this rolling!
Alhanouf Alaskar
03:02:57
appreciate what you have shared with us
Alhanouf Alaskar
03:02:59
thank you
Laurie Wennerholm
03:03:02
Thank you Liz, Clare and Georgia. This was so great.
Colette Ellis
03:03:05
Thank you!
Sri Nandamudi
03:03:06
Thank you so much! Very helpful.
Carolyn Perry
03:03:06
The telepractice jenie will NOT go back into the bottle!!!!!!
Shira Wachtel
03:03:08
Thank you so much!
Erin Schmidt
03:03:13
Absolutely fantastic information! So grateful to hop on the trail you’ve blazed.
Erin Redle Sizemore
03:03:16
thank you!
Mauricio Gonza8
03:03:19
Thank you. This was excellent !
Susan Shonbrun
03:03:22
Thank you very much. Very, very helpful information.
Arun Balaji K D
03:03:24
Great webinar
Yelenna Marrero
03:03:30
Thank you for sharing all your knowledge! Wonderful!
Juliana D'Innocenzo
03:03:32
Thank you!
Lissa Greenwald
03:03:34
Thank you
Jenisse Cortés
03:03:34
Thank you very much!!
Yonnelis Dominguez
03:03:35
Thank you for all the information!
Michael Peterson
03:03:36
Thanks so much all, very helpful information!
Wilma Benitez
03:03:45
Thank you!
Susan Sneed
03:03:58
This was very helpful; thank you so much! We have a lot to think about and apply at our university clinic!
Dawn Wetzel
03:03:59
Thanks for your time and dedication. Very helpful information!
Isabel Robles
03:04:09
Thank you!!
Lymarie Ortiz
03:04:11
thank you
Mathew Andrews
03:04:13
Thank you
Rinki Varindani Desai
03:04:15
Thank you to the panelists for a very informative talk. We appreciate you taking the time and expertise to educate us!
Migdelys Camacho
03:04:18
thank you
Jenna Milburn
03:04:22
what was the last website mentioned?
Jenna Pellegrini
03:04:28
Dawn Wetzel!!! Hi!!! I went to Purdue (Jenna Olson...2012)
Michele Wilkerson
03:04:30
Thank you
Ana Millon
03:04:31
Thank you very much!
Shirley Matos
03:04:35
Thank you!!
Raghad Alshubaily
03:04:36
Thank you