Pre-Treatment SLP Evaluation

What do we need to understand for Pre-treatment SLP evaluation?

• Pt’s baseline function

  • Speech and swallow not always WNL

• Pt’s needs and current knowledge

Pre-treatment SLP evaluation is an opportunity for what?

early education and counseling

Early intervention may support what?

improved long-term outcomes

Patient Reported Outcomes (PROs)

before, during, and after tx

• Private insurers are looking to PROs as measure of improvement in allied health

• SLP must demonstrate functional outcomes AND PROs

• QOL measures differ by site and clinician preference

QOL measures differ by site and clinician preference

Many cancer specific options available

1. FACT- H&N

2. UW-QOL-R

3. MDADI

FACT-H&N

The Functional Assessment of Cancer Therapy-Head and Neck

• Widely used in cancer trials

• Assesses 12 items specific to HNC

UW-QOL-R

University of Washington QOL Head and Neck Questionnaire- revised

• 10 HNC specific items

MDADI

• MD Anderson Dysphagia Inventory

• Widely reported in the cancer literature

• Specific to swallow function

  • Emotional, functional, physical subscales

  • Global score

SLP HNC Evaluation Components

Includes typical SOAP components

Baseline function is so important to document!

S

PMH, case history from pt interview

case history from pt interview

• current swallow function

• diet

• where the cancer is

• speech changes (tongue cancer)

• unintentional weight loss

• how long does it take to eat a meal?

• plan of treatment (chemo, RT, surgery)

O

• Voice use habits and vocal hygiene

• Perceptual voice evaluation and/or acoustic and aerodynamic measures

• Informal speech assessment

• Oral mech/cranial nerve evaluation

• Swallow assessment (bedside, MBSS, FEES)

• Education/therapy (side affects)

Perceptual voice evaluation and/or acoustic and aerodynamic measures

MPT, respiratory support, voicing

A

Diagnosis and assessment

P

Treatment recs, prognosis statement, swallow recs, goals

Initial Visit- Educational Resources for the Patient

1. HNC overview video

2. overview of appointments

3. anatomy

4. overview of acute radiation effects

5. EAT through radiation treatment

6. IDDSI

7. preventive swallow exercise program during RT

8. overview of late radiation effects

9. you must keep swallowing! 

   1. the best exercise for swallowing is swallowing

HNC overview video

talk through in the 1st visit. they have something to reference later

overview of appointments

1. dx with ENT

2. who is on the team→first SLP visit (pre-treatment evaluation, daily exercise program)

3. start treatment→ daily exercise program

4. ½ point (4 weeks into treatment)→ 2nd SLP visit, daily exercise program

5. end treatment→ weekly SLP visits

anatomy overview

• where is the highest dose going to be delivered

• not just the tongue, but the field of surrounding areas

• will experience a change in some degree of function

overview of acute radiation effects

how these changes have a functional impact

more difficulty after treatment

EAT through radiation treatment

talk through IDDSI, as things get harder, stair step down to easier level (softer, added moisture)

preventive swallow exercise program during RT

prophylactic therapy, 3x a day

• ROM stretching: open heart, shoulder shrug, neck stretch, strap muscles stretch (look up, open mouth)

• elevation/closure of airway: mendelsohn, glides

• BOT & pharyngeal squeeze: masako, effortful swallow

What are 2 examples each of topics covered during education/counseling with a pt during their initial visit?

counseling

1. expectant symptoms/acute side effects

2. timeline of RT

education

1. anatomy

2. how to move up and down the staircase of diet textures