The guidelines say to manage risk. But what if the guidelines are the problem? In this episode of Dysphagia Research Bites, Dr Shaun O'Keeffe and I unpack his critique of the Royal College of Physicians' guidance on eating and drinking difficulties, and we ask the question that too few clinicians are asking: is our fear of aspiration actually driving good practice, or just driving restriction?

In this episode we cover:

• The difference between aspiration and aspiration pneumonia, and why conflating them causes harm
• Why dietary modifications and thickened fluids are not evidence-based strategies for preventing pneumonia
• The BOLUS Framework and why Shaun takes issue with how it frames risk
• Why "unsafe swallow" is a term that needs to go
• The evidence, or lack of it, behind nil by mouth orders for dysphagic patients
• Informed consent, patient choice, and why quality of life has to be part of the conversation
• Why the profession is at a crossroads between risk-averse practice and evidence-based care

The article this episode is based on:

O'Keeffe, Shaun & Murray, Aoife & Leslie, Paula & Collins, Lindsey & Lazenby-Paterson, Tracy & Mccurtin, Arlene & Mulkerrin, Siofra & Smith, Alison. (2021). Aspiration, risk and risk feeding: A critique of the royal college of physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing. 1-10. 10.3233/ACS-210031.

If you've ever felt uncertain about whether cervical auscultation belongs in your clinical toolkit, this episode is for you. In this episode of Dysphagia Research Bites, Chantelle sits down with Associate Professor Liza Bergstrom to unpack the evidence behind cervical auscultation, why it became so controversial, and why recent high-quality research suggests it deserves a proper place in your clinical swallow evaluation.

In this episode we cover:

·      What cervical auscultation actually is and where to place the stethoscope

·      Why CA became controversial and why that controversy may have been based on a misunderstanding of its intended purpose

·      The five key components to listen for during oral trials using the Respiratory Swallow Assessment Protocol

·      How CA complements the clinical swallow exam rather than replacing instrumental assessment

·      What the research says about validity, accuracy and reliability of CA compared to FEES

·      The role of training in improving reliability and what training options are available

·      Whether CA can detect silent aspiration and what its limitations are

The publication this episode is based on:

Bergström L, Cichero J, Jaghbeer M, Sutt AL. Respiratory-swallow assessment protocol for adult dysphagia management. BMC Res Notes. 2025 Nov 27;19(1):60. doi: 10.1186/s13104-025-07509-4. PMID: 41310723; PMCID: PMC12903235.

If you'd like some further reading on CA, please check out the articles below:

• https://link.springer.com/article/10.1007/s00455-022-10468-8
• https://www.tandfonline.com/doi/full/10.1080/17549507.2021.1953592#abstract
• https://onlinelibrary.wiley.com/doi/full/10.1111/coa.14202?msockid=077fa973c35469500a04bf97c2d968d3
• https://pubmed.ncbi.nlm.nih.gov/30019178/
• https://www.asha.org/siteassets/uploadedfiles/icf-swallowing.pdf

If you’ve been on the fence about CA or you’ve written it off, this episode is for you!

In this episode, Chantelle sits down with Tiffani Wallace, a dysphagia specialist with a passion for rehabilitation, to break down a 2016 case series study on the Intensive Dysphagia Rehabilitation Approach (IDRA) ™ in patients with neurogenic dysphagia.

In this episode they cover:

• What the IDR approach actually involves and why it's more accessible than it sounds
• The three core components of the program: oropharyngeal exercises, high intensity targeted swallowing practice and adherence-inducing features
• The principles of neuroplasticity underpinning the approach — and how to apply them in everyday practice
• Why focused, targeted exercises beat a long list of unproven techniques every time
• Why 60 bolus swallows per day is less daunting than it sounds — and why it matters

Be sure to check out Tiffani's work at www.dysphagiaramblings.net or find her on Instagram at @dysphagia_ramblings.

The publication this episode is based on: Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K. The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study. Arch Phys Med Rehabil. 2016 Apr;97(4):567-574. https://doi.org/10.1016/j.apmr.2015.11.019

Note: DPNS stands for Deep Pharyngeal Neuromuscular Stimulation

In part 2, Chantelle continues her conversation with Jackie Rodriguez, SLP, picking up where they left off on the dual diagnosis of dysphagia and dementia.

In this episode they cover:

• How dementia affects the visual field and what this can mean at mealtimes
• Practical approaches to assessing vision and how you can compensate for these impairments in your management approach
• Using sensory strategies at mealtimes, including how something as simple as separating food into individual bowls can support attention and reduce overwhelm
• Enteral feeding and what the evidence actually says about whether it prevents aspiration pneumonia
• Jackie's approach to oral apraxia: the tips, tricks and techniques she uses in practice
• Proactive swallowing therapy and why early intervention matters in this population
• The hill Jackie dies on when it comes to dysphagia care at end of life

Be sure to check out Jackie's ebook: The SLPs Guide to Dementia which you can access through Teachers Pay Teachers or through her instagram page: @unlearnwithme.theslp

The publication this episode is based on: Dysphagia in Persons with Dementia: The Dual Diagnosis Challenge Author: Michelle Tristani Publication: Perspectives of the ASHA Special Interest GroupsVolume 1, Number 15, Pages 105-116https://doi.org/10.1044/persp1.SIG15.1

Dysphagia & Dementia: What we need to learn & unlearn

If you're a speech pathologist working with adults with dementia, you already know that dysphagia doesn't show up in isolation. It shows up alongside memory loss, behavioural & sensory changes, communication breakdowns and alongside an aging swallow.

In part 1 of this episode of Dysphagia Research Bites, Chantelle sits down with Jackie Rodriguez, Speech-Language Pathologist, to unpack the dual diagnosis challenge of dementia and dysphagia, and why assessing swallowing in this population requires a fundamentally different clinical lens.

In this episode we cover:

• Why dementia and dysphagia together present a unique and underrecognised clinical challenge
• Jackie's story of how this became an area of interest
• An introduction to the article: Dysphagia in Persons with Dementia: The Dual Diagnosis Challenge by Michelle Tristani
• A discussion on terminology and why the language we use with this population matters
• Functional approaches to assessing dysphagia in adults with dementia
• Some cognitive assessments that SLPs should know about 

Assessments mentioned in this episode:

• Dementia Mealtime Assessment Tool (DMAT)
• Environment & Communication Assessment Toolkit (ECAT) for Dementia Care
• The Saint Louis University Mental Status (SLUMS) 
• The Mini Mental State Examination (MMSE)
• Cognitive Linguistic Quick Test (CLQT)
• Global Deterioration Scale (GDS)

Be sure to check out Jackie’s ebook: The SLPs Guide to Dementia

You can find it here: https://www.teacherspayteachers.com/Product/The-SLPs-Guide-to-Dementia-11781923

The publication this episode is based on: Dysphagia in Persons with Dementia: Tristani, M (2016). The Dual Diagnosis Challenge. Perspectives of the ASHA Special Interest Groups

Volume 1, Number 15 Pages 105-116

https://doi.org/10.1044/persp1.SIG15.105

If you're a speech pathologist working in the community, you already know it feels different to the hospital. But did you know the research actually backs that up? In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Simone Howells from Griffith University to unpack her research on community-based dysphagia practice and why the skills that made you great in the hospital might need a rethink when you step into someone's home.

In this episode we cover:

• Why community-based dysphagia care requires an adapted skillset and mindset
• The three key themes from Simone's research: holistic practice, client autonomy, and carer engagement
• The unique challenges of working without a multidisciplinary team
• How grief, loss, and psychosocial factors show up in community dysphagia practice
• Why new graduates may feel underprepared for community roles — and what universities are doing about it
• The importance of curiosity and conversation over rushing straight to assessment
• Cultural considerations in community dysphagia care
• Where the research gaps are and why community practice deserves more attention

The publication this episode is based on: Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. Int J Lang Commun Disord. 2019 Nov;54(6):971-981. doi: 10.1111/1460-6984.12499. Epub 2019 Sep 3. PMID: 31479197.

Where to find the resources mentioned:

• Beyond the Blender cookbook (second edition): www.beyondtheblender.com.au
• Goal-setting handout: https://dysphagia-bites.kit.com/interviewguide