NDoscopy Dysphagia Specialists, 85 East End Avenue Suite 1C, New York, NY (2025)

04/23/2025

Educating Patients About FEES: Tips for SLPs

Flexible Endoscopic Evaluation of Swallowing (FEES) can be intimidating for patients—especially when they hear the word "endoscope." As SLPs, we play a key role in helping them feel informed, safe, and comfortable.

Here’s how to effectively educate patients about FEES:

🔹 Use Clear, Simple Language
Avoid clinical jargon. Instead of “nasal insertion of a flexible endoscope,” say “a small camera gently goes through your nose so we can watch how you swallow.”

🔹 Set Expectations
Explain what they’ll feel: “It might feel like a tickle or pressure in your nose, but it shouldn’t hurt.” Walk them through the steps of the exam so there are no surprises.

🔹 Emphasize the Purpose
Reassure them that this test helps us see what’s happening inside in real-time and tailor treatment to keep swallowing as safe and efficient as possible.

🔹 Normalize the Experience
Let them know it’s a common procedure and part of routine swallowing evaluations. Mention that it’s used for all ages and settings, even at the bedside. We have done this procedure on ourselves, so we mention that too!

🔹 Offer Reassurance
Stay calm, confident, and supportive. Your tone helps reduce anxiety. A simple “You’ve got this—we’ll talk you through the whole thing” goes a long way. Sometimes counting to 3 also helps so they know that the nasal part will be through quickly.

When patients understand why we’re doing FEES and what to expect, they’re more likely to feel comfortable and trust the process.

04/20/2025

Happy Easter from NDoscopy Dysphagia Specialists. Thank you to our consultants and all the SLPs helping our patients.

04/18/2025

📢 PEG Feeding in Advanced Dementia: What the Research Says

🧠 Did you know? Studies, including a Cochrane Review (2021), show that enteral tube feeding in severe dementia does NOT:
❌ Improve survival
❌ Enhance quality of life
❌ Reduce pain or mortality
❌ Decrease behavioral symptoms
❌ Improve nourishment
❌Benefit caregivers' mental health

⚠️ Instead, evidence suggests an increased risk of pressure ulcers and other complications.

💡 What’s the alternative? A focus on comfort, hand-feeding, and person-centered care may be more beneficial.

🔬 Source: Davies et al., Cochrane Database of Systematic Reviews, 2021.

04/15/2025

💬 Grateful SLP Moment 🙏

Just received this thoughtful text from a fellow SLP! 💙 It's always so rewarding to see how our FEES (Flexible Endoscopic Evaluation of Swallowing) services helps our colleagues get clearer insights into their patients' swallowing and voice function.

Thank you to this amazing Speech Pathologist for trusting me with the FEES test and for the kind words! It’s all about teamwork and providing the best care for our patients. 👩‍⚕️👨‍⚕️

Here’s to more successful assessments and improving patient outcomes together! 💪

04/11/2025

🧠 Parkinson’s Disease & Swallowing: Understanding Dysphagia & Aspiration Risk 🚨

Parkinson’s disease (PD) affects more than just movement—it also impacts swallowing (dysphagia), increasing the risk of aspiration (when food or liquid enters the airway). In particular, dysphagia is significantly associated with malnutrition and aspiration pneumonia in PD, with the latter being a leading cause of death in this population (Baijens & Speyer, 2009; Beyer et al., 2001; Johnston et al., 1995; Kalf et al., 2012; Wang et al., 2002). Dysphagia also negatively impacts quality of life, with patients reporting restricted participation in social activities involving eating and drinking.

Silent aspiration is also a concern for Parkinson's Disease, with up to 15% of patients in some studies.

🔍 How Does PD Affect Swallowing?
✅ Delayed swallow initiation ⏳
✅ Reduced tongue and throat muscle coordination
✅ Silent aspiration (food/liquid entering the airway without a cough)

📢 Why Use Flexible Endoscopic Evaluation of Swallowing (FEES)?
FEES is a gold-standard tool for assessing swallowing in PD patients. It allows clinicians to:
🔬 Directly visualize airway protection
🍽️ Evaluate real-time swallowing function with different food textures
🚫 Detect aspiration, even when silent
🏋️‍♂️Provide individualized therapy programs

Early intervention is key! If you or a loved one with Parkinson’s is experiencing swallowing difficulties, talk to a speech-language pathologist (SLP) for a comprehensive assessment.

💙

04/09/2025

🍽️ SLPs, Let’s Talk Swallowing Research! 🔬📚

Dysphagia management is constantly evolving, and staying up to date with evidence-based research is key to providing the best care for our patients. From VFSS and FEES to diet modifications and exercise-based interventions—research guides our practice every day!

💡 What’s one swallowing-related research article that has changed the way you treat dysphagia? Drop it in the comments! Let’s build a go-to list for SLPs! ⬇️✨

04/04/2025

🌟📢 Speaking Valves for Tracheostomy Patients During Instrumental Swallow Assessments

When assessing swallowing function in patients with a tracheostomy, speaking valves are essential tools!
💬 These devices help improve airflow through the upper airway to allow for voicing, improved secretion management, improved cough strength and may improve swallowing and reduce aspiration in some patients. FEES is preferred over MBS for most patients with tracheostomy so that we can assess secretions, airway patency and potential for decannulation--- check out my courses on tracheostomyeducation.com for more information!

When performing a FEES, the patient can be assessed in 3 different conditions:
🔹 Cuff up (if cuff is present)
🔹Cuff down
🔹Cuff down and speaking valve in place

🔍 Why speaking valves are important during FEES:

Improved Vocalization: Speaking valves help restore speech, providing critical information about the airway function, swallowing and vocal fold mobility.

Enhanced Assessment: With a speaking valve in place, we can better assess laryngeal function and airway protection during swallowing, ensuring a comprehensive evaluation.

Better Outcomes: Swallowing may be improved and some patients may reduce aspiration risk when speaking valves are placed.

Remember: Always consult with a skilled speech-language pathologist to determine the appropriate timing and use of a speaking valve for each individual patient.

🌟check out tracheostomyeducation.com for my courses such as Evidenced Based Swallowing Management for Patients with Tracheostomy and Decannulation🌟 link in bio

🔗

04/01/2025

Impact of Dysphagia on Quality of Life

Dysphagia, or difficulty swallowing, has far-reaching effects beyond the act of eating. It can significantly impact a patient’s physical and mental well-being.

🔹 Reduced Physical Safety: Dysphagia increases the risk of aspiration pneumonia, choking, and malnutrition, all of which compromise physical health and safety.

🔹 Negative Mealtime Experiences: The fear of choking, long meal times, and difficulty swallowing can take away the joy of eating, creating anxiety around food.

🔹 Reduced Social Engagement: Avoiding social situations that involve meals can lead to isolation, as individuals with dysphagia may feel embarrassed or uncomfortable eating in front of others.

🔹 Reduced Choice and Control: With interventions like texture-modified diets or enteral nutrition, patients face limitations in their food choices and independence, which can feel disempowering.

🔹 Impact on Physical Health: Malnutrition, weight loss, and dehydration can worsen the effects of dysphagia, leading to a cycle that negatively impacts overall health.

🔹 Mental Health: The constant challenges posed by dysphagia can lead to anxiety, depression, and a loss of self-esteem, affecting emotional well-being.

Understanding these challenges is crucial to supporting individuals with dysphagia. With the right care and interventions, we can help improve quality of life. For patients on feeding tubes or mechanically altered diets, a reassessment may be indicated to determine if restrictions can be removed.

Instrumental assessments such as FEES can directly view the swallow process to determine swallow physiology and individualized therapy based on impairment. 💙

03/28/2025

Dementia affects 55 million people worldwide, with 10 million new cases each year (WHO, 2021). 50% of individuals in skilled nursing facilities have dementia (Alzheimer’s Association, 2021) and 45-57% of those with dementia have dysphagia (Easterling & Robbins, 2008). Nearly half of individuals with dementia experience dysphagia (swallowing difficulties), and aspiration, including silent aspiration are also common (Suh, Kim, & Na, 2009).

SLPs play a vital role in assessing and managing swallowing difficulties, ensuring safety and quality of life.

FEES is a great tool for patients with dementia as an alternative to MBS.

✅ Strategies for Success:
✔️ Modify the Protocol – Shorten the procedure or use alternative approaches
✔️ Involve Caregivers – Familiar faces provide comfort & insight
✔️ Use Distraction Techniques – Music, conversation, or calming strategies
✔️Use a calm, reassuring approach
✔️Conduct FEES in a quiet, familiar environment
✔️ Keep instructions simple & use non-verbal cues

💡 SLPs are essential in dysphagia management for those with dementia, ensuring dignity, safety, and better quality of life until end of life.

We have found most patients with dementia are successful using these strategies. Do you have any other strategies that you utilize?

📌 Save & share to raise awareness!

03/26/2025

The "Evidence Map of Clinical Practice Guideline Recommendations on Stroke Rehabilitation" provides key insights into best practices for stroke recovery. 🔍✨
🧠According to the "Evidence Map of Clinical Practice Guideline Recommendations on Stroke Rehabilitation", patients at risk for pharyngeal dysphagia or poor airway protection (based on bedside swallowing assessments) should undergo further testing with either:

✅ Videofluoroscopic Swallow Study (VFSS/MBS) or
✅ Fiberoptic Endoscopic Evaluation of Swallowing (FEES

📌 Other Key Takeaways:
✔️ Multidisciplinary Care is essential for optimal recovery.
✔️ Early Rehab improves long-term outcomes.
✔️ Task-Specific Training enhances motor recovery.
✔️ Cognitive & Psychological Support are crucial for holistic rehab.

Do you use instrumental assessments for patients with stroke with risk for pharyngeal dysphagia or poor airway protection?

03/25/2025

Many patients enter skilled nursing facilities (SNFs) on mechanically altered diets after hospitalization. But are these diet changes still necessary? 🤔

📊 Key Findings from a Study:
🔹 No agreement was found between pre- and post-imaging diet levels.
🔹 67% of patients on modified diets (solids/liquids) did NOT have dysphagia.
🔹 100% of patients without dysphagia still received treatment for it.
🔹 61% of patients with feeding tubes had no dysphagia.
🔹 45% of NPO (nothing by mouth) patients had imaging before discharge.

⚠️ Why does this matter?
Unnecessary diet modifications can lead to poor nutrition, dehydration, and reduced quality of life. Repeating imaging and accurate assessments (like FEES or MBS) are crucial for ensuring patients are not unnecessarily restricted.

👩‍⚕️ SLPs play a vital role in making evidence-based recommendations and improve quality of life! ✅

great study!!
Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc. 2024 Feb;25(2):381-386. doi: 10.1016/j.jamda.2023.11.008. Epub 2023 Dec 15. PMID: 38109943.
📌 Save & share to raise awareness!

03/22/2025

Here to help support SLPs I protecting residents and helping their patients.

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