Tuesday, June 24, 2014

A team approach creates successful rehab outcomes and reduces the need for surgical intervention

By:  Christopher Davis, MD, ENT, Carleen Ozley, MS, CCC-SLP, and Daniel Valentine, PhD, CCC-SLP

"Collaboration, communication and comprehensiveness" best defines the unique experience of our patients with vocal dysfunction when seen for assessment, diagnosis and intervention in the Voice Lab at Excel ENT of Alabama, Birmingham, Ala. We provide visualization and interpretation of a patient's larynx to assess vocal fold appearance and function. Unique in this practice, however, is the implementation of interprofessional education and practice (IPE). Recent articles in the ASHA Leader have argued that IPE is a responsive framework to provide best practice to our patients, as well as sharing information with colleagues and with the education students.

The Voice Lab at Excel ENT provides comprehensive examinations using state of the art technology for visual inspection and acoustical analysis (Kay Pentax distal chip flexible endoscopy and/or rigid endoscopy), and interpretations and recommendations are made in collaboration with both the speech language pathologist and the otolaryngologist. The patient also participates in establishing his personal voice plan of care, and personal patient goals are established based on his daily voice use. The team approach, however, does not begin and end at the assessment phase, but is extended when providing treatment to patients with voice disorders. An interdisciplinary approach has long been the accepted model when providing services to patients with cleft palate and craniofacial anomalies,3 and a team approach with patients with vocal dysfunction is becoming the standard.

The Excel ENT Voice Referral Team consists of an otolaryngologist, a speech language pathologist with specialization in voice, a psychologist, a yoga instructor, a vocal coach, an audiologist and a massage therapist. Based on the patient's plan of care, we will work together to help the patient meet his goals. Because of the voice team care approach, patients at Excel ENT have experienced successful rehabilitation outcomes, which has reduced need for surgical intervention.

EXCEL Voice and Swallowing Institute In her recent article, Patty Prelock, PhD, CCC-SLP, challenged our profession to integrate IPE in the communication sciences and disorders curricula and it is with this vision that we have recently established the EXCEL Voice and Swallowing Institute. The mission of the institute is three-fold:

1) provide education to undergraduate and graduate students in speech pathology,
2) offer clinical internships in the areas of assessment and treatment of voice disorders, and
3) provide a comprehensive training program for endoscopy.

This advanced program consists of three levels of clinical experience for speech language pathologists who are interested in furthering their skills for endoscopy, interpretation and vocal rehabilitation. SLPs' use of endoscopy to diagnose swallowing disorders in hospitals and long-term care facilities is becoming more common, as is observing vocal fold function with patients with vocal dysfunction. ASHA's Scope of Practice6 includes the use of endoscopy by speech language pathologists and the Special Interest Divisions 3 and 13 have provided a thorough document on the skills and knowledge for SLPs practicing endoscopy.

However, very few graduate programs offer training in endoscopy and policies regulating this practice often vary from state to state. A goal of this program is to provide a comprehensive and transparent protocol to train SLPs to be competent endoscopists. Excel ENT has partnered with the University of Montevallo Speech and Hearing Clinic, Montevallo, Ala., and in collaboration with faculty members Dan Valentine, PhD, and Chris Gaskil, PhD, will provide observation hours for graduate students in the areas of voice and swallowing.

Spreading the Word We are passionate in sharing their experience, interests, and current clinical setting so that a greater number of patients with vocal disorders can be better served. They are actively engaged in sharing their expertise in various mediums. Recently they have been contributors to the Birmingham Medical News and have addressed allergists and asthma physicians in the diagnosis and treatment of Paradoxical Vocal Cord Disorder (PVCD).

One of the patients summarized Davis' successful practice approach best when he stated, "This is the best experience I have had at any doctor's visit." For further information and most current happenings at Excel ENT of Alabama please visit our website.

Christopher Davis completed his medical degree at the University of Alabama and his residency at The Ohio State University. He has been in private practice for 9 years and specializes in the care of sinus and voice disorders.

Carleen Ozley has been a part of the Voice Care Team since 2012 after completing 36 years at the Birmingham VA Medical Center.

Daniel Valentine is an assistant professor at the University of Montevallo and conducts research and teaches classes in the areas of stuttering, voice and motor speech.

References: 1. Prelock P. The magic of interprofessional teamwork. The ASHA Leader 2013;18(6): 5-6. 2. Pickering J. et al. So long, silos. The ASHA Leader 2013;18(6): 38-43. 3. Austin AA, et al. Interdisciplinary craniofacial teams compared with individual providers: Is orofacial cleft care more comprehensive and do parents perceive better outcomes? Cleft Palate-Craniofacial Journal 2010;47(1): 1-8. 4. Farely E. et al. An interdisciplinary approach to voice disorders. UNWOMJ 2011;80(2): 24-26. http://www.uwomj.com/wp-content/uploads/2012/03/ENT_09.pdf 5. Stadelman-Cohen T et al. Team management of voice disorders in singers. The ASHA Leader 2009. http://www.asha.org/Publications/leader/2009/091124/Team-Management-Voice-Disorders-Singers.htm 6. American Speech-Language-Hearing Association (2007). Scope of Practice in Speech-Language Pathology. doi:10.1044/policy.SP2007-00283. 7. American Speech-Language-Hearing Association. Knowledge and Skills for Speech-Language Pathologists With Respect to Vocal Tract Visualization and Imaging 2004. Doi: 10.1044/policy.KS2004-00071. http://www.asha.org/policy/KS2004-00071.htm 8. American Speech-Language-Hearing Association. Role of the Speech-Language Pathologist in the Performance and Interpretation of Endoscopic Evaluation of Swallowing: Guidelines 2004. doi:10.1044/policy.GL2004-00059. http://www.asha.org/docs/html/GL2004-00059.html

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