The aging population is rapidly growing, requiring speech–language pathologists to better manage ... more The aging population is rapidly growing, requiring speech–language pathologists to better manage a caseload that includes older adults who have a variety of needs. The purpose of this review is to summarize and discuss the current available evidence that will allow speech–language pathologists to make informed clinical decisions when working with older adults. To facilitate this, this article first establishes an understanding of both normal and disordered swallowing physiology in older adults, including how to differentiate between functional changes to swallowing (presbyphagia) and dysphagia. Other important factors to consider, such as caregiver burden, are also discussed so that clinicians can learn how to best support aging in place. Best practices for screening both community-dwelling older adults and residents of long-term care are identified as part of a framework introduced to guide decision making. The critical components of clinical swallow assessments are reviewed, inclu...
Previous research has begun to elucidate the physiological impairments associated with dysphagia ... more Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration–Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid sw...
Archives of physical medicine and rehabilitation, Jan 8, 2018
To assess consensual validity, inter-rater reliability and criterion validity of the Internationa... more To assess consensual validity, inter-rater reliability and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS), a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. Participants assigned IDDSI-FDS scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Inter-rater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. Web-based survey. 170 respondents from 29 countries. N/A MAIN OUTCOME MEASURES: Consensual validity (% agreement, Kendall's tau), criterion validity (Spearman rank correlation), inter-rat...
Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture... more Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels...
Perspectives of the ASHA Special Interest Groups, 2016
A graduate-level course in dysphagia is an integral part of the graduate curriculum in speech-lan... more A graduate-level course in dysphagia is an integral part of the graduate curriculum in speech-language pathology. There are many challenges to meeting the needs of current graduate student clinicians, thus requiring the instructor to explore alternatives. These challenges, suggested paradigm shifts, and potential available solutions are explored. Current trends, lack of evidence for current methods, and the variety of approaches to teaching the dysphagia course are presented.
The larynx is situated between the pharynx and the trachea as part of the upper airway. It contri... more The larynx is situated between the pharynx and the trachea as part of the upper airway. It contributes to phonation, respiration, and protection of the tracheobronchial tree from aspirations. Laryngeal anatomy and physiology is complex, hence pathologies in structure and function can lead to a broad spectrum of symptoms. Although an otolaryngologist usually performs evaluations of the larynx, and the speech– language pathologist evaluates function in the context of voice and swallow, the pulmonary physician will also encounter patients with respiratory symptoms due to laryngeal diseases. For a bronchoscopist, therefore, detailed surveillance should include descriptions of functional and anatomical findings. Prior to an endoscopic examination, pertinent information, including clinical history, pulmonary function test, and computed tomography images should be reviewed, as laryngeal pathologies can cause non-specific signs and symptoms. A heightened clinical suspicion, therefore, can a...
Objectives ____________________________________________________ Define culture and describe its e... more Objectives ____________________________________________________ Define culture and describe its effects on communication and its assessment/treatment. • Outline best practices for nonbiased assessment of children with suspected communica- • tion disorders. Outline procedures for the use of interpreters in the clinical practice of a speech-lan- • guage pathologist.
Infection control and hospital epidemiology, Jan 10, 2015
OBJECTIVE Evidence is lacking on the preventive effect of oral care on healthcare-associated pneu... more OBJECTIVE Evidence is lacking on the preventive effect of oral care on healthcare-associated pneumonia in hospitalized patients and nursing home residents who are not mechanically ventilated. The primary aim of this review was to assess the effectiveness of oral care on the incidence of pneumonia in nonventilated patients. METHODS We searched 8 databases (MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, LILACS, ICHUSHI, and CiNii), in addition to trial registries and a manual search. Eligible studies were published and unpublished randomized controlled trials examining the effect of any method of oral care on reported incidence of pneumonia and/or fatal pneumonia. Relative risks (RR) and 95% confidence intervals were calculated. Risk of bias was assessed for eligible studies. RESULTS We identified 5 studies consisting of 1,009 subjects that met the inclusion criteria. Of these, 2 trials assessed the effect of chlorhexidine in hospitalized patients; 3 studies examined mechanical ora...
To address disparities in access to health care information, we developed a model program of comm... more To address disparities in access to health care information, we developed a model program of community-based, health education workshops to be delivered in English and Spanish to older urban adults from diverse ethnic, cultural, and language backgrounds. The workshops were created through an interdisciplinary collaboration among faculty from seven health care professions and focused on three healthcare topics identified in Healthy People 2010: dementia and depression, stress reduction, and physical activity. The development of workshop content and structure, including didactic and interactive components, an approach to interdisciplinary student involvement, and program evaluation by clients and community center staff, are presented as a model for other educators. The workshops presented at five senior centers were attended by 1110 mostly female clients with an average age of 74 yrs and with a large proportion self-identified as of minority background. One hundred seven students from...
Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 2015
The clinical swallow examination (CSE) is widely used by clinicians evaluating patients with dysp... more The clinical swallow examination (CSE) is widely used by clinicians evaluating patients with dysphagia, yet this method remains controversial among many. The composition and purpose of the CSE are highly variable by region, facility, age group and individual clinician. This article will review literature on the topic and present clinical practice suggestions to further its usefulness and ongoing investigation.
The aging population is rapidly growing, requiring speech–language pathologists to better manage ... more The aging population is rapidly growing, requiring speech–language pathologists to better manage a caseload that includes older adults who have a variety of needs. The purpose of this review is to summarize and discuss the current available evidence that will allow speech–language pathologists to make informed clinical decisions when working with older adults. To facilitate this, this article first establishes an understanding of both normal and disordered swallowing physiology in older adults, including how to differentiate between functional changes to swallowing (presbyphagia) and dysphagia. Other important factors to consider, such as caregiver burden, are also discussed so that clinicians can learn how to best support aging in place. Best practices for screening both community-dwelling older adults and residents of long-term care are identified as part of a framework introduced to guide decision making. The critical components of clinical swallow assessments are reviewed, inclu...
Previous research has begun to elucidate the physiological impairments associated with dysphagia ... more Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration–Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid sw...
Archives of physical medicine and rehabilitation, Jan 8, 2018
To assess consensual validity, inter-rater reliability and criterion validity of the Internationa... more To assess consensual validity, inter-rater reliability and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS), a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. Participants assigned IDDSI-FDS scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Inter-rater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. Web-based survey. 170 respondents from 29 countries. N/A MAIN OUTCOME MEASURES: Consensual validity (% agreement, Kendall's tau), criterion validity (Spearman rank correlation), inter-rat...
Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture... more Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels...
Perspectives of the ASHA Special Interest Groups, 2016
A graduate-level course in dysphagia is an integral part of the graduate curriculum in speech-lan... more A graduate-level course in dysphagia is an integral part of the graduate curriculum in speech-language pathology. There are many challenges to meeting the needs of current graduate student clinicians, thus requiring the instructor to explore alternatives. These challenges, suggested paradigm shifts, and potential available solutions are explored. Current trends, lack of evidence for current methods, and the variety of approaches to teaching the dysphagia course are presented.
The larynx is situated between the pharynx and the trachea as part of the upper airway. It contri... more The larynx is situated between the pharynx and the trachea as part of the upper airway. It contributes to phonation, respiration, and protection of the tracheobronchial tree from aspirations. Laryngeal anatomy and physiology is complex, hence pathologies in structure and function can lead to a broad spectrum of symptoms. Although an otolaryngologist usually performs evaluations of the larynx, and the speech– language pathologist evaluates function in the context of voice and swallow, the pulmonary physician will also encounter patients with respiratory symptoms due to laryngeal diseases. For a bronchoscopist, therefore, detailed surveillance should include descriptions of functional and anatomical findings. Prior to an endoscopic examination, pertinent information, including clinical history, pulmonary function test, and computed tomography images should be reviewed, as laryngeal pathologies can cause non-specific signs and symptoms. A heightened clinical suspicion, therefore, can a...
Objectives ____________________________________________________ Define culture and describe its e... more Objectives ____________________________________________________ Define culture and describe its effects on communication and its assessment/treatment. • Outline best practices for nonbiased assessment of children with suspected communica- • tion disorders. Outline procedures for the use of interpreters in the clinical practice of a speech-lan- • guage pathologist.
Infection control and hospital epidemiology, Jan 10, 2015
OBJECTIVE Evidence is lacking on the preventive effect of oral care on healthcare-associated pneu... more OBJECTIVE Evidence is lacking on the preventive effect of oral care on healthcare-associated pneumonia in hospitalized patients and nursing home residents who are not mechanically ventilated. The primary aim of this review was to assess the effectiveness of oral care on the incidence of pneumonia in nonventilated patients. METHODS We searched 8 databases (MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, LILACS, ICHUSHI, and CiNii), in addition to trial registries and a manual search. Eligible studies were published and unpublished randomized controlled trials examining the effect of any method of oral care on reported incidence of pneumonia and/or fatal pneumonia. Relative risks (RR) and 95% confidence intervals were calculated. Risk of bias was assessed for eligible studies. RESULTS We identified 5 studies consisting of 1,009 subjects that met the inclusion criteria. Of these, 2 trials assessed the effect of chlorhexidine in hospitalized patients; 3 studies examined mechanical ora...
To address disparities in access to health care information, we developed a model program of comm... more To address disparities in access to health care information, we developed a model program of community-based, health education workshops to be delivered in English and Spanish to older urban adults from diverse ethnic, cultural, and language backgrounds. The workshops were created through an interdisciplinary collaboration among faculty from seven health care professions and focused on three healthcare topics identified in Healthy People 2010: dementia and depression, stress reduction, and physical activity. The development of workshop content and structure, including didactic and interactive components, an approach to interdisciplinary student involvement, and program evaluation by clients and community center staff, are presented as a model for other educators. The workshops presented at five senior centers were attended by 1110 mostly female clients with an average age of 74 yrs and with a large proportion self-identified as of minority background. One hundred seven students from...
Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 2015
The clinical swallow examination (CSE) is widely used by clinicians evaluating patients with dysp... more The clinical swallow examination (CSE) is widely used by clinicians evaluating patients with dysphagia, yet this method remains controversial among many. The composition and purpose of the CSE are highly variable by region, facility, age group and individual clinician. This article will review literature on the topic and present clinical practice suggestions to further its usefulness and ongoing investigation.
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Papers by Luis Riquelme