“You’re asking for what??”

Hello friends and faithful BLOG followers!

As many of you have probably seen, I began a crowdfunding campaign on ifundwomen.com to help purchase some equipment for the Clinic.  I wanted to take some time to talk about the equipment because I did not have enough time to do that in my 3 minute pitch!

The first item I want to talk about, is the fiberoptic endoscopic Evaluation of Swallowing (FEES).  Below, I have put a video from the MAYO Clinic’s YouTube page, that shows what happens in this specific type of evaluation.  You will see that it’s an endoscope with a light-source and camera that goes through a person’s nose and looks down into their throat!  A FEES allows us (SLP’s) to view the structures & tissues in the throat (pharynx), watch food/liquids (with green food coloring in them) as they pass over the base of your tongue, through your throat, and hopefully, down into your esophagus!  We look for a variety of things during this study, but what we want to make sure we do not see, is green in the trachea, which indicates aspiration.  

For some people, and for different reasons, the food or drink may scatter, or it might pass through the vocal folds (aspiration) and into the trachea before the person can initiate a swallow.  Or, sometimes, we will see green food under the curly thing (epiglottis) or in those dark holes to the left and right of the epiglottis (the pyriform sinus cavities).   Sometimes, there’s a cervical vertebrate that creates a bump in the pharynx and causes food to get “stuck,”  Sometimes, if the person has been intubated, the pharyngeal cavity will be bruised, swollen, or will have a vocal fold that does not close all the way.  Sometimes a person’s upper esophageal sphincter does not open far enough, and their food cannot pass to the esophagus.  All of those findings have specific implications, which helps us know EXACTLY what you need to work on to improve your swallowing, and what will drive your therapy plan.  Essentially, it takes the “guessing” out of the swallow evaluations, which allows for a more targeted approach to the deficits, and will allow the SLP to help the patient improve their swallowing faster.


So, why do I NEED to have a FEES at Resurgence?

In order to provide the level of care I want to provide to my clients, I need to be able to SEE what is happening when they swallow.  Our profession has performed swallow evaluations without FEES for many years, by performing a cranial nerve assessment, taking a medical history, and observing the person swallowing, called a clinical swallow exam (CSE).  However, there have been several research studies that compare the accuracy of the CSE, videofluoscopic study (modified barium swallow study,) and FEES.  All this research has found that our accuracy during a CSE was less than 50% effective.



I’m going to step up on my soap box, grab my megaphone, and quote a study here.

“Compromising Simultaneous Clinical Swallow Evaluations and Fiberoptic Endoscopic Evaluations of Swallowing:  Findings and Consequences,” by Steven B. Leder, published in Perspectives on Swallowing and Swallowing Disorders (dysphagia) Volume 4, February 2015.  (https://pubs.asha.org)

Dr. Leder took a group of SLPs, (with a collective average of 19 years of experience in dysphagia management!!) divided them into 2 groups; 1 group evaluated 4 recorded CSEs and the other group analyzed the FEES video for the same 4 patients.  After reading the case histories and reviewing the evaluations, each SLP had to rate the 4 patients’ anatomy & physiology and bolus flow characteristics (how the foods/drink passes through the throat,) and then rate the safety of the patient’s swallow.

Here is what Leder said about the clinician’s (who are highly experienced) accuracy,

“There was no agreement between the CSE and the FEES ratings…when watching the CSE alone, results indicated an 83% inability to determine pharyngeal and laryngeal anatomy and physiology, 90% inability to determine the bolus flow characteristics… and 88% inability to determine overall swallow safety.”

Let me rephrase that! 

The clinicians’ abilities to judge a person’s swallow was LESS THAN 17%.

Leder goes on to say,

“When watching the FEES video alone, all 7 viewers were able to determine pharyngeal and laryngeal anatomy and physiology, bolus flow characteristics, and whether a safe swallow occurred with 100% accuracy.”

So, Leder found in 2015, that flexible fiberoptic endoscopic evaluation of swallowing was 100% accurate, where the clinical bedside evaluation, alone, was less than 17%.

That, my dear followers, is why I NEED the FEES.  I cannot evaluate what I cannot see.  I refuse to provide services that are 17% accurate, when I could provide services that are 100% accurate. 

(And I could go on a rant here, about how SLP’s around the country are being denied access to instrumental swallow studies, at a detriment to their patients, but I will not.  Maybe another time.  I was one of those SLP’s and that is why I will own the equipment.)

Now, lets talk about the training that goes into me being able to complete a FEES. First, I had to take an introduction class.  This is not something they taught me in graduate school!  Performing FEES is a special skill that not every SLP has.  Once I took the intro class, I had to have a mentor; luckily, back in 2015 when I took the class, I had a mentor available to me.  I had to do a specific number of “passes” (which is me putting the scope in, assessing the swallow, and writing a report) on friends at work.  THEN, I had to complete a specific number of passes on patients, interpret what I saw, and write a report, which was all supervised by my mentor.  Because it has been so long since I’ve done this, I will be hiring a new mentor, to allow me to refresh my skills and ensure that I am truly competent to perform this type of evaluation.  This process, of course, costs money.  All together, the education to be able to perform this type of assessment costs around $3,000.00.

The equipment includes the endoscope, a light source, a computer with a program that allows me to record the evaluation, look at it frame-by-frame, and compile it al into a beautiful report to send to a patient’s physician, and a highly protective case to store it all in.  That equipment costs around $20,000.  PLUS, I need to purchase the high-level disinfectant, insurance to cover damaged equipment,  and a container to clean the endoscope in, oh, and a lockable, metal cabinet for storage.  

Now we know the reason why many small private practices do not conduct FEES; it is very expensive.  However, after reading the research, I can’t, in good conscience, NOT provide the most accurate type of swallow evaluation for my community. 

And so, I decided to leap out of my comfort zone, and ask for some help.  Because, the FEES isn’t the only equipment that I need to provide the standard of service I feel morally obligated to provide.  Purchasing all the equipment would take me several years to do and cause me to provide substandard speech therapy services in the interim.  With your help, I can provide effective swallow, voice, speech/language, and cognitive evaluations/treatments to my community, from the very start.   Not only will you be my hero, but you will be someone else’s too!

If you’re feeling generous, or looking for something tax deductible, please consider supporting Resurgence Neuro Rehab in my quest to provide evidence based speech therapy services to the Concord, NC area.  The campaign can be found here:  https://ifundwomen.com/projects/resurgence-neuro-rehab-0

I am flattered by everyone’s support!