INTENSIVE LEARNING PROGRAM
Dietitians of Canada is pleased to present
PROGRAM
It is almost 10 years since DC staff and leaders of the
Dysphagia Assessment and Treatment Network met to dream about enhancing the skills and knowledge of the dietitian and other members of the interprofessional dysphagia team working with individuals with dysphagia. This learning retreat builds upon the tools created and education offered since that first meeting in 2001 and provides the opportunity to take your practice to the next level. This one-of-a-kind intensive program brings together leading experts from Canada,
Australia and the US in the fields of nutrition, rehabilitation therapies and speech-language pathology for an in-depth look at the science and art of assessing and managing dysphagia.
LEARNING OBJECTIVES
At the conclusion of this event, participants will have:
1.
enhanced their understanding of the physiological and neurological causes of dysphagia,
2.
acquired knowledge of various methods of assessment for swallowing disorders and the appropriate use of those methods in different settings,
3.
increased their appreciation of the interrelationships between respiration, positioning and eating,
4.
deepened their expertise in hydration, food texture and nutrient density,
5.
expanded their repertoire of adaptive and compensatory strategies for dysphagia management,
6.
increased their confidence in the importance of their contributions to the interdisciplinary care team, and
7.
strengthened their networks and connections to other dietitians across the country.
A certificate of program completion will be provided.
LOCATION
Delta Vancouver Suites
550 West Hastings Street,
Vancouver BC, V6B 1L6
Morris J Wosk Centre for Dialogue, Simon Fraser University
580 Hastings Street,
Vancouver BC, V6B 1L6
Speakers
Caren Carlaw, MA, CCC-SLP was the project lead and the lead research investigator in an interdisciplinary team at GF Strong that set out to develop, implement and evaluate a water protocol, which is now known as the GF Strong Water Protocol. Their results have been widely reported and are pending publication. She is currently working at Surrey Memorial Hospital as an
Interim Clinical Practice Leader and is a Clinical
Associate Professor at UBC.
Dr. Julie Cichero, BA, BSp,Thy, PhD is a dedicated specialist of feeding and swallowing disorders. For 19 years Julie has worked in public and private adult acute, rehabilitation and extended care facilities and more recently with babies and children. Julie has been a lecturer and researcher affiliated with The University of Queensland since 1996. She is an invited national and international speaker, author and reviewer for a number of international health journals.
Dr. Wendy Dahl, PhD, RD, FDC is an Assistant Professor in the Food Science and Human Nutrition Department,
University of Florida and holds adjunct faculty status in the College of Pharmacy and Nutrition University of
Saskatchewan. Wendy has been involved in research and development of texture-modified foods for a number of years leading to the publication of the DC resource
“Modified Texture Food Production: A Manual for Patient
Care Facilities” as well as a number of peer-reviewed publications. She has presented on texture-modified foods nationally and internationally, and is also a frequent reviewer of grants and manuscripts on this topic.
Jan Duivestein, MRSc, OT/PT is a combined trained therapist (OT/PT) who has worked in the area of dysphagia for over 20 years. She works with children and adults with developmental conditions and complex feeding/swallowing problems. She also works in team environments and highly values the skills and knowledge of her fellow team members which include dietitians, physicians, nurses, social workers and SLP’s. Jan teaches the dysphagia curriculum to the OT students at
UBC and has presented on dysphagia in adult and pediatric populations at local, national and international workshops and conferences. continued…

MONDAY, MARCH 7 2011
9:00 a.m.
Welcome and opening remarks
Presented by: Peter Lam
9:15 a.m.
How did we get to where we are now in managing dysphagic children and adults?
Speaker: Dr. Michael Groher
10:30 a.m.
REFRESHMENT BREAK
11:00 a.m.
Standardized terminology journey – learnings from Australia
Speaker: Dr. Julie Cichero
12:00 p.m.
LUNCH (icebreaker)
1:00 p.m.
Breakout sessions A
A1 - Interviewing & medical history
Speakers: Dr. Robert Miller & Dr. Michael Groher
A2 - Mealtime management and respiration
Speaker: Dr. Julie Cichero
A3 - Nutritional adequacy and nutrient density of diets for dysphagia
Speaker: Dr. Wendy Dahl
2:10 p.m.
Breakout sessions (repeat of A1-A3)
3:10 p.m.
REFRESHMENT BREAK
3:30 p.m.
Breakout sessions (repeat of A1-A3)
4:40 p.m.
Q & A session & wrap up of day #1
Facilitator: Peter Lam
6:00 p.m.
DINNER continued…
Speakers
- continued
Dr. Michael Groher, PhD is a professor and chair of the
Department of Communicative Disorders at the University of Redlands in Redlands, California. His work with dysphagic patients is summarized in three texts:
Dysphagia: Diagnosis and Management; Introduction to
Adult Swallowing Disorders; and most recently with
Dr. Crary, Clinical Management of Dysphagia in Adults and
Children (2009). This text is enriched by a website
(Evolve) at Elsevier. The site offers many case solving problems and instrumental assessment results.
Dr. Groher is an ASHA Fellow, and an associate editor for the journal Dysphagia.
Peter Lam, RD, CFE (Credentialed Foodservice Executive) provides nutrition and food service systems consultation to health care facilities, retirement corporations, food service & hospitality industry clients, educational institutions and several government organizations. Peter has presented many workshops and lectures to national and international audiences. He is the co-author of the
Dietitians of Canada Online Dysphagia course and the role discussion paper for Dietitians of Canada to identify the knowledge and skills required by registered dietitians in dysphagia treatment and management. Peter is the
Chairperson for the College of Dietitians of British
Columbia and the immediate Past National President of the Canadian Association of Food Service Professionals
(CAFP).
Dr. Robert Miller, PhD, CCC-SLP, BC-ANCDS, Fellow-
ASHA is senior lecturer in Speech and Hearing
Sciences at the University of Washington and an adjunct lecturer in the School of Medicine. He worked for 30 years in VA medical centers and received a
Distinguished Career Award from the Department of
Veterans Affairs. He was awarded an Outstanding
Clinical Achievement Award from Washington Speech and Hearing Association, and an Erskine Fellowship from the University of Canterbury in Christchurch, New
Zealand. He has published 3 texts and numerous journal articles in dysphagia and neurogenic disorders.

- continued…
TUESDAY, MARCH 8 2011
6:30 a.m.
Run/walk
8:00 a.m.
BREAKFAST
8:40 a.m.
Opening remarks
Presented by: Peter Lam
8:45 a.m.
Current dysphagia treatment/rehabilitation:
What are they and what do we need to know?
Speaker: Dr. Michael Groher
9:40 a.m.
Breakout sessions B
B1 - Physical assessment
Speaker: Dr. Robert Miller
B2 - Supporting successful mealtimes: positioning, environmental and personal strategies
Speaker: Dr. Jan Duivestein
B3 - Textural and physical properties of food for safe swallowing
Speaker: Dr. Wendy Dahl
10:40 a.m.
REFRESHMENT BREAK
11:00 a.m.
Breakout sessions (repeat of B1-B3)
12:00 p.m.
Lunch - look, taste & learn
(Sponsor Showcase & Exhibit)
1:30 p.m.
Breakout sessions (repeat of B1-B3)
2:40 p.m.
Breakout sessions C
C1 - Implementing a water protocol in a rehabilitation setting
Speaker: Caren Carlaw
C2 - Spoonful of sugar makes the medicine go down
Speaker: Dr. Julie Cichero
3:40 p.m.
REFRESHMENT BREAK
4:00 p.m.
Breakout sessions (repeat of C1-C2)
5:00 p.m.
Faculty panel discussion, Q & A session & wrap up
Facilitator: Peter Lam
WEDNESDAY, MARCH 9 2011
6:30 a.m.
Run/walk
8:00 a.m.
BREAKFAST
8:45 a.m.
Working in an interprofessional environment
Speakers: Dr. Robert Miller & Peter Lam
9:45 a.m.
Case studies
1 - Neurological case study
Speaker: Dr. Robert Miller
2 - Oesophageal dysphagia, impact on the oropharyngeal system: a case study
Speaker: Dr. Julie Cichero
3 - Malnutrition and food texture: a case study
Presented by: Dr. Wendy Dahl
10:30 a.m.
REFRESHMENT BREAK
10:50 a.m.
Making it real
12:00 p.m.
Closing remarks & evaluation
Presentation of certificates of program completion

Session Descriptors
9:15 a.m.
How did we get to where we are now in managing dysphagic children and adults?
Speaker: Dr. Michael Groher
Speech-language pathologists were involved in the diagnosis and treatment of adult dysphagics in the early 1970s although it was not approved in ASHA’s scope of practice. It was apparent that the best care could only be provided with a multi-disciplinary approach. As teams began to cooperate in patient care, it became apparent that a research base needed to be established if the sub-specialty of dysphagia management was to continue. This resulted in the development of a multidisciplinary journal, Dysphagia, in 1986, and the formation of the Dysphagia Research Society in 1991.
11:00 a.m.
Standardized terminology journey – learnings from Australia
Speaker: Dr. Julie Cichero
Following a national multidisciplinary project (2007), Australia adopted standardized terminology and definitions for texture modified foods and fluids. In 2010, evaluation of uptake of the standards was completed. Speech pathologists, dietitians, nurses, nutrition assistants, food service managers and cooks of metropolitan, rural and remote facilities contributed to the evaluation. The new standards have been successfully implemented in a majority of facilities. The associations will engage further with other stakeholders (e.g. aged care associations, nurses, food services); update supporting education material; and develop resources to assist implementation. This session will discuss the journey, benefits of standardization, and enablers and barriers to implementation.
1:00 p.m. / 2:10 p.m. / 3:30 p.m.
A1 - Interviewing & medical history
Speakers: Dr. Michael Groher & Dr. Robert Miller
The presenters will address the process of conducting clinical interviews and reviewing the medical record to obtain essential information pertinent to impairments in swallowing. Conducting a thorough records review, asking appropriate questions and probing for detail are critical steps in making a determination regarding the diagnosis and effective interventions.
1:00 p.m. / 2:10 p.m. / 3:30 p.m.
A2 - Mealtime management and respiration
Speaker: Dr. Julie Cichero
Coordination between respiration and swallowing is critical for swallowing safety.
This session will cover normal swallowrespiratory cycles for liquids and solids. It will address swallow-respiratory changes that occur in dysphagic populations
(e.g. stroke, COPD). It will also address how the respiratory system affects other body systems. Using this background, this session will provide practical suggestions for improving mealtime management (e.g. bolus alterations, determination of patient mealtime stamina, and respiratory techniques to promote safer mealtimes). In addition it will provide information on risk factors for development of aspiration pneumonia and methods of minimizing these risks.
1:00 p.m. / 2:10 p.m. / 3:30 p.m.
A3 - Nutritional adequacy and nutrient density of diets for dysphagia
Speaker: Dr. Wendy Dahl
Malnutrition due to numerous macronutrient and micronutrient inadequacies is common in individuals consuming diets modified for the management of dysphagia. This interactive session will explore the critical issues of malnutrition in individuals with dysphagia, and its impact on health, wellness and quality of life. Practical recommendations for insuring adequate nutrient density of marginal nutrients such as protein, fiber and various micronutrients in in-house prepared foods will be explored. The nutrient content and acceptability of commercially-available foods for dysphagia will be explored. In addition, strategies for implementation of target nutrient densities will be developed.

Session Descriptors
8:45 a.m.
Current dysphagia treatment/rehabilitation: what are they and what do we need to know?
Speaker: Dr. Michael Groher
This session will review the extant behavioral treatments for adult dysphagics; indications for, procedures, and published outcomes.
9:40 a.m. / 11:00 a.m. / 1:30 p.m.
B1 - Physical assessment
Speaker: Dr. Robert Miller
Dr. Miller will address the process of conducting a clinical examination of the adult patient with dysphagia. Clinical observations pertinent to swallowing, techniques for inspecting relevant head and neck musculature, and knowledge regarding the interpretation of findings will be covered in a hands-on learning milieu.
9:40 a.m. / 11:00 a.m. / 1:30 p.m.
B2 - Supporting successful mealtimes: positioning, environmental and personal strategies
Speaker: Dr. Jan Duivestein
The ability to successfully eat and drink in various contexts is of primary importance to individuals experiencing dysphagia.
This session will offer participants a practical approach to managing mealtime challenges that arise for individuals with dysphagia. Dr. Duivestein will review the literature regarding common issues that arise with posture and positioning and the impact on swallowing function. Environmental and personal factors will also be discussed. Practical solutions that enable successful mealtimes will be presented with opportunities for participants to “test drive” these solutions.
9:40 a.m. / 11:00 a.m. / 1:30 p.m.
B3 - Textural and physical properties of food for safe swallowing
Speaker: Dr. Wendy Dahl
Appropriate textural and physical properties of foods are critical to safe swallowing, however, achieving consistent goal properties for dysphagia management are challenging. This interactive session will explore the various textural and physical properties of common foods, the modification of these characteristics in normal mastication, and how to simulate these characteristics in foods intended for individuals with dysphagia. In addition, food preparation methods and recommendations to achieve goal textures, and quality considerations for in-house and commercially prepared texturemodified foods will be discussed.
2:40 p.m. / 4:00 p.m.
C1 – Implementing a water protocol in a rehabilitation setting
Speaker: Caren Carlaw
This session presents an inter-professional process and framework for implementing a water protocol in a rehabilitation setting. Ms. Carlaw will discuss the rationale for a water protocol, including issues of safety and effects on patient satisfaction, quality of life, and fluid intake. A specific algorithm for assigning candidates to supervised or independent water access will be demonstrated, including frequency, techniques, and tools for oral care protocols with and without suction. The research on the GF Strong Water protocol will be summarized and the impact on client satisfaction, quality of life and fluid intake discussed.
2:40 p.m. / 4:00 p.m.
C2 – Spoonful of sugar makes the medicine go down
Speaker: Dr. Julie Cichero
Medications have become the mainstay of medical ‘treatment’. Side effects of medications, such as dry mouth and reduced level of consciousness pose significant safety issues for patients with dysphagia. Also, approximately 18% of the healthy people find it difficult to swallow their tablets. As many as 83% of solid dose medications in acute care and 34% in aged care, are modified at bed-side. These alterations may lead to toxicity, or decrease medication efficacy. Many pharmaceutical companies will not warrant their medications if they are not administered as prescribed. This presentation will address the impact of dysphagia on medication administration, efficacy and patient compliance.

Session Descriptors
8:45 a.m.
Working in an interprofessional environment
Speakers: Dr. Robert Miller & Peter Lam
Working with patients who are experiencing symptoms of dysphagia requires dynamic interprofessional interaction; specifically, clear communication and strategic planning for both assessment and intervention purposes is critical to achieve successful outcomes. The presenters in this session will describe examples of interprofessional teams and discuss practical methods to achieve clinical goals.
9:45 a.m.
Case Studies
1) Neurological case study
Speaker: Dr. Robert Miller
A brief case description of a patient with degenerative neurological disease will be used to illustrate the importance of understanding the diagnosis and the disease progression, obtaining critical historical information, conducting a relevant physical assessment, and providing evidenced-based recommendations and patient education at the proper time.
2) Oesophageal dysphagia, impact on the oropharyngeal system: a case study
Speaker: Dr. Julie Cichero
This session will use the case of a 55 year old female with a long history of oesophageal dysphagia to illustrate the impact of oesophageal disorders on oropharyngeal swallowing, nutrition and quality of life. The session will include information regarding the anatomy and physiology of the oesophagus, incorporating structural and muscular reasons for dysfunction. Through this case study clinicians will learn about gastroesophageal reflux and achalasia. Behavioural, medical and surgical management of oesophageal disorders are provided. The important, although often neglected issues relating to quality of life and depression are also discussed.
3) Malnutrition and food texture: a case study
Speaker: Dr. Wendy Dahl
A brief case description of a long term care patient with dementia will be used to illustrate the interrelationships between food texture, nutrient density, food intake and the development of malnutrition. The importance of communication among the care staff, food service staff and the interdisciplinary team will be discussed.

Participants are responsible for registration fees in addition to travel, accommodation and any other associated or incidental expenses.
Once confirmed, you will receive more information about travel and hotel arrangements.
(plus 12% HST)
DC Members - $900.00
Non-members - $1,350.00
05
Notice of cancellation must be made in writing to EMAIL: frances.scovil@dietitians.ca.
A $450.00 cancellation fee (plus 12%
HST) will apply for conference registrations cancelled up to February 7,
2011 after which no refunds will be issued except in approved circumstances.
Application Deadline
January 7, 2011
Application Notice of Decision
January 14, 2011
Acceptance and Registration
January 21, 2011
Cancellation Deadline
February 7, 2011
Corinne Eisenbraun
Dietitians of Canada
TEL: 204.235.1792
EMAIL: corinne.eisenbraun@dietitians.ca
www.dietitians.ca
I www.dietetistes.ca
This Intensive Learning Program is open to a maximum of forty (40) participants.
We request you complete the application information below and include a covering letter telling us what you hope to get out of this learning retreat and how you expect to apply the learning in your practice.
Participants applying for registration should have a good practicing knowledge of: normal and abnormal oral, nasal, pharyngeal, laryngeal and esophageal anatomy and physiology for respiration, airway protection and swallowing, interrelationship between swallowing and respiration, typical medical/disease and age-related condition which can contribute to changes in anatomy and physiology of the swallow, potential medication effects on swallowing, and entry level assessment skills for swallowing. Refer to the discussion paper on the role of the dietitian in assessment (see link below).
Due to the anticipated interest in this program and the limited spaces available, please apply by Friday January 7, 2011 to ensure your application is considered.
Prior to the start of the program, participants accepted for registration should familiarize themselves with:
“Role of the Registered Dietitian in Dysphagia Assessment and Treatment –
A Discussion Paper” at: http://www.dietitians.ca/Knowledge-Center/Resourcesfrom-A-Z/Dysphasia.aspx?categoryID=12
Name (Last, First)
Mailing Address
City
Phone
Province
Email
Postal Code
Organization
I am a DC Member
 Yes  No
I have included my covering letter
 Yes  No
I am able to attend this program in its entirety

Yes

No
Completed applications must be emailed to the Dietitians of Canada by
Friday, January 07, 2011.
ATTN: Corinne Eisenbraun
Dietitians of Canada
TEL: 204.235.1792
EMAIL: corinne.eisenbraun@dietitians.ca
Notification of application receipt will be emailed to all applicants.
Selection of applicants will be made by email no later than January 14, 2011.
Applicants will have until January 21, 2011 to confirm their registration.