Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist.

PURPOSE: From preschool through high school, eating is part of the school day. Children with feeding and/or swallowing issues are now in our neighborhood schools, our responsibility in our care, and require adequate nutrition and hydration to participate in school and access the curriculum. The whole child is in school, including all of their medical, behavioral, social, and educational needs. This clinical focus article describes a holistic process of evaluating swallowing and feeding in the school setting for the school speech-language pathologist (SLP) leading the team supporting the child. METHOD: This clinical focus article explores the evaluation process in the educational setting for the school SLP in identification of pediatric feeding disorders (PFDs), which can involve dysphagia. Detailed descriptions of the related U.S. educational law, PFD, assessment processes for the multiple systems relating to eating, and collaboration with an interdisciplinary team are highlighted. Using the four overlapping domains of PFD (medical, psychosocial, feeding skill-based systems and associated nutritional aspects), medical and background history gathering; integration with instrumental results; and the need to consider the complex interaction of developmental, physical, cognitive, social, behavioral, family, and cultural aspects in the evaluation are detailed. CONCLUSIONS: School-age children require safe and adequate nutrition and hydration for learning and social participation. The SLP has a lead role in the school team in evaluating swallowing and feeding, and developing a plan for team implementation. A holistic school-based SLP clinical evaluation process is described.

Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review.

PURPOSE: To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS). MATERIALS AND METHODS: Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered. RESULTS: A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes. CONCLUSIONS: Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.Implications for RehabilitationMultidisciplinary care using a needs-based approach with the individual- and group-based interventions, may be more beneficial than usual care.Younger populations, particularly females, seem to benefit most from multidisciplinary care to decrease the burden of post-concussion symptoms.Multidisciplinary care teams should consider providing psychological support and education combined with cognitive retraining and pharmacologic intervention to address persistent post-concussion symptoms.