providing dysphagia support in the school setting
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PROVIDING DYSPHAGIA SUPPORT IN THE SCHOOL SETTING. Dysphagia Policies & Procedures. It is a team approach All team members have different responsibilities All team members need training based on their roles - PowerPoint PPT PresentationTRANSCRIPT
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Dysphagia Policies & Procedures
It is a team approach
All team members have different responsibilities
All team members need training based on their roles
Parents are a very important member of the team and should be included from the beginning
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Students identified with dysphagia
Must have a signed doctor order with food and liquid recommendations if any changes are being made to them
Must have an emergency plan for choking/aspiration
Staff must be trained on emergency plan and safe swallow strategies (different for all children)
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Special Education & Regular Education
Most of the children who are identified with dysphagia are receiving special education services
If they are not; we need to determine if the child has any medical diagnosis related to the feeding problem; (OHI)
Children receiving all regular education services and have dysphagia fall under health services with the nurse
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Evaluations
All evaluation requests are completed through an ARD
Two types of evaluations: Bedside Swallow Evaluation and a Modified Barium Swallow Study
Evaluations must have parent and physician approval
If a child develops dysphagia or enrolls with a diagnosis; then a temporary emergency plan is followed and completed until an evaluation is completed
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Normal Anatomy
http://www.radiographicceu.com/article23.html
Signs of Aspiration
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Michelle
Staff shared concerns with feeding Michelle had diagnosis of Retts Syndrome (a progressive disease)
and takes medication for seizures (some cause sedation) ARD committee recommended a BS (parents & physician agreed) Feeding/Swallowing plan developed with diet of cut solids and
regular liquids The following school year arrived and Michelle was having
difficulty eating again (with concerns enough to call 911) Observations and data collection determine the need for a MBSS MBSS was completed at the campus with parents Michelle demonstrated regression and this was difficult for the
parents to hear and accept New diet recommendations were pureed solids and regular
liquids Michelle is now doing better, eating safely at school, and she is
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Anthony Staff shared concerns with feeding (including refusal of foods,
decreased chewing, and vomiting frequently) ARD committee recommended a BS (parents and physician agreed) Anthony demonstrated severe food aversions and did not chew food Recommendations at review ARD included going to a G.I. to rule out
any medical complications and to have a MBSS MBSS was completed and it showed a severe pathology in the
esophegeal stage of swallowing (esophageal stricture) Esophageal stricture is a narrowing or tightening of the esophagus
that causes swallowing difficulties Diet recommendations were pureed solids and regular liquids Anthony was referred to a GI with the new evaluation results Parents reported that they followed up with the G.I.; no specific
recommendations were required by us A feeding/swallowing plan was developed and the staff was trained Anthony is eating safely at school, and he continues to work on
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Esophageal stricture: Narrowing or tightening of the esophagus that causes swallowing difficulties.
Avery Staff shared concerns with feeding (not
chewing well) Avery had a diagnosis of a hearing impairment
and other medical issues ARD committee recommended a BS (parents
and physician agreed) Feeding/swallowing plan was developed with
diet recommendations of cut/chopped soft foods and regular liquids
Avery had objectives to improve chewing skills At her next annual ARD, Avery made great
progress; she was able to chew solids foods without difficulty
Avery was dismissed from dysphagia support
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Dysphagia DataYear Trainings Observations Evaluations
08-09 50 52 32
09-10 47 75 42
10-11 34 78 30
11-12 On going 74 35
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DYSPHAGIA DATA
11/17/08 dysphagia caseload 112 students
2/1/12 dysphagia caseload 150 students
CFISD STATISTICS
84 schools including special facilities 107,995 students
Thank You
In the Cypress-Fairbanks School District students are continually begin monitored by terrific staff and family members. Each member of the dysphagia team is necessary, important, and contributes to the success of the student. Our goal is for students to gain adequate nutrition and hydration safely. This supports their health and educational needs.
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Resources for Dysphagia
The Source for Dysphagia 3rd Ed. By Nancy B. Swigert (Linguisystems)
The Source for Pediatric Dysphagia 2nd Ed. By Nancy B. Swigert (Linguisystems)
The Source for Oral-Facial Exercises By Debra C. Gangale (Linguisystems)
The Manuel of Paediatric Feeding Practice By Arlene McCurtin (Speechmark)
Just Take A Bite By Lori Ernsperger, Ph.D and Tania Stegen-Hanson, OTR/L (Future Horizons)
Bedside Evaluation Dysphagia By Edward Hardy (Imaginart)
Follow The Swallow By Jo Puntil-Sheltman (Amazon) Pre Feeding Skills By Suzanne Evans Morris (Amazon)