RESUMEN
Background: There is growing evidence to support the use of ultrasound as a tool for the assessment and treatment of speech, voice and swallowing disorders across the Speech and Language Therapy profession. Research has shown that development of training competencies, engagement with employers and the professional body are vital to progressing ultrasound into practice. Methods: We present a framework to support translation of ultrasound into Speech and Language Therapy. The framework comprises three elements: (1) scope of practice, (2) education and competency and (3) governance. These elements align to provide a foundation for sustainable and high-quality ultrasound application across the profession. Results: Scope of practice includes the tissues to be imaged, the clinical and sonographic differentials and subsequent clinical decision-making. Defining this provides transformational clarity to Speech and Language Therapists, other imaging professionals and those designing care pathways. Education and competency are explicitly aligned with the scope of practice and include requisite training content and mechanisms for supervision/support from an appropriately trained individual in this area. Governance elements include legal, professional and insurance considerations. Quality assurance recommendations include data protection, storage of images, testing of ultrasound devices as well as continuous professional development and access to a second opinion. Conclusion: The framework provides an adaptable model for supporting expansion of ultrasound across a range of Speech and Language Therapy specialities. By taking an integrated approach, this multifaceted solution provides the foundation for those with speech, voice and swallowing disorders to benefit from advances in imaging-informed healthcare.
RESUMEN
This case study describes a 21-year-old male with congenital myotonic dystrophy referred to respiratory physiotherapy with a weak cough and upper respiratory tract secretions. Mechanical insufflation-exsufflation (MI-E) was prescribed. Post initiation, the patient described a worsening of secretions and increased attendances to hospital with suspected chest infection. He also described difficulties with speaking after use of MI-E. Multidisciplinary assessment of cough as well as bulbar and swallow function resulted in a primary diagnosis of oro-pharyngeal dysphagia as well as weak cough. An alternative prophylactic therapy programme including active cycle of breathing, chest wall percussions, and manually assisted cough, was prescribed to facilitate clearance of upper airway secretions and patient comfort. The case highlights some of the risks associated with cough augmentation techniques derived from single-discipline intervention in the neuromuscular patient population. Comprehensive multidisciplinary assessment and management were key to redefining this patient's diagnosis, allowing effective and individualised treatment.
