Supporting clinical decisions with physiologically guided metrics

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Clinical DecisionsBoth needed

Objective Subjective

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Clinical DecisionsBalance

Objective Subjectivepatient report

palpationdiet

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Clinical DecisionsBalance

Objective Subjectivelab valuesaspiration presencemm of hyoid movement

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Dysphagia Management

Objective Subjectivepatient reportclinical exam

dietpalpation

confirm swallow

swallowing metrics (msec,mm)confirm aspiration

5

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

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metric units, ranking, scoring measure

millimeters, counting, seconds

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

7

metric units, ranking, scoring measure

highly reliable observation: death, amputee

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Function OBJ SBJ Neither!

lingual ROM

lingual strength (non swallow)

lingual strength (swallow)

labial ROMlabial strength

jaw ROM

jaw strength

swallow presence

swallow onset time

swallow duration

Clinical ExaminationObjective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

9

metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would consistently make the same decision

Person 1

square square square square

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

10

metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would consistently make the same decision

Person 1 - encounter 2

square square square square

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

11

metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would consistently make the same decision

Person 2

square square square square

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

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metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would have the same outcome across multiple judgements

this judgement actually measures what you think it measures

weight, not volume

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

13

metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would have the same outcome across multiple judgements

this judgement actually measures what you think it measures

Normal values can be differentiated from abnormal values

Objective Subjective

Numeric Value

Obvious Judgement

Reliability (within-person & between-person)

Validated

Normative Values

14

metric units, ranking, scoring measure

highly reliable observation: death, amputee

you and/or someone else would have the same outcome across multiple judgements

this judgement actually measures what you think it measures

Normal values can be differentiated from abnormal values

Goal of Objective Swallowing Outcomes

Support your clinical recommendations

Establish presence of disorder (normative values)More reliable for intra- & inter-clinician judgements

Can be tracked throughout pt care

diagnosis treatment follow up

better

worse

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SLP A - Hey I’m thinking about buying X device. Anyone use it?

SLP B - Yes! I love X device. I’ve seen lots of success

IH - Cool! Can you define success?

SLP B -

Each of us can do a clinical exam

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But how objective vs subjective is it?

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Down the Hatch Podcast excerpt“why do SLPs get away with more than PTs can”

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Activity

The clinical examination How objective vs subjective is it?

Videofluoroscopy

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How objective vs subjective is it?

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Function OBJ SBJ Neither

swallow presence

hyo-laryngeal

ROM

lingual function

swallow delay

pharyngeal contriction

LVC

Videofluoroscopy ExaminationFEES

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How objective vs subjective is it?

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Function Objective Subjective Don’t even try!Lingual ROM

Clinical Eval