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1. Discuss the development and interrelationships between the respiratory and gastroesophageal systems
2. Describe the impact of respiratory and gastrointestinal functioning on swallowing
3. Identify respiratory and gastroesophageal disease processes for which dysphagia is a symptom
4. Describe the evidence to support various diagnostic tools such as reflex cough testing, pulse oximetry, and clinical and instrumental swallowing assessment
5. Identify common indicators of reflux and how they impact the treatment process
6. Discuss which patients are most at risk for developing aspiration pneumonia

RESPIRATORY SYSTEMS

• Overview of systems - anatomy/physiology
• Breathing/Swallowing coordination
• The apneic signal
• The relationship of coordination to aspiration
• Laryngeal Chemical Responses (LCRs)
• Reflexive cough

GASTROESOPHAGEAL SYSTEMS

• esophageal function 
• Barriers to reflux
• Saliva swallows
• Digestive acids
• Reflux mechanisms  
• Relationship to feeding disorders  
• GERD signs and symptoms u
• When does GER become GERD?
• Reflux, feeding and swallowing behaviors
•  Relationship to dysphagia

GI/RESPIRATORY RELATIONSHIPS

• Pressure relationships and their effect u
• Asthma/gastroesophageal reflux connection
• Laryngopharyngeal Reflux (LPR)

ASPIRATION

• Pulmonary Clearance Mechanisms
• Aspiration in infancy
• How much is too much?
• Predictors of pneumonia in various populations
• Aspiration and oral hygiene

RESPIRATORY DISEASE PROCESSES

• Infant Respiratory Distress Syndrome (IRDS)
• Bronchopulmonary Dysplasia (BPD)
• Respiratory Synctial Virus (RSV)
• Congenital Heart defects
• Obstructive Sleep Apnea (OSA) and dysphagia
• Congestive Heart Failure (CHF)
• Obstructive Conditions
• Restrictive Conditions
• Pneumonia vs Pneumonitis
• Community Acquired Pneumonia
• Healthcare Acquired Pneumonia
• Aspiration Pneumonia

AIRWAY MANAGEMENT

• Non-invasive positive pressure ventilation
• High flow nasal cannula
• Intubation
• Post-extubation dysphagia
• Tracheostomies
• Physiological changes associated with tracheotomy

ASPIRATION ASSESSMENT

• Clinical assessment – what are we looking for?
• Cognitive assessment
• Pitch elevation
• Serial swallows
• Oral mechanism
• Respiratory factors
• Cough
• Respiratory muscle strength
• Instrumental assessment
• Modified Barium Swallow studies
• Fiberoptic Endoscopic Evaluation of Swallowing
• 3 ounce water tests
• Understanding lab values

ASPIRATION MANAGEMENT

• Diet modifications
• Implications of dietary changes
• Compliance issues
• Thick liquids
• Complicating factors associated with thickening
• Water protocols
• Compensatory strategies
• Sensory interventions
• Principles of exercise physiology
• Lingual strengthening
• Effortful swallow
• Mendolsohn maneuver
• Masako maneuver
• Shaker head lift
• Chin tuck against resistance
• Head extension exercise
• Jaw opening exercise
• Tongue pull back
• Effortful pitch glide
• Expiratory muscle strength training

REFLUX ASSESSMENT

• Upper GI studies
• Ph Monitoring
• Esophagoscopy
• Scintigraphy

REFLUX MANAGEMENT

• Lifestyle modifications
• Positioning
• Diet modifications
• Medications
• Effects of acid suppression
• Surgical interventions
• New directions in reflux management
• Endoscopic procedures
• Melatonin
• Acupuncture
• Magnetic Sphincter Augmentation

Angela Mansolillo, MA/CCC-SLP, BCS-S, is a speech-language pathologist and Board-Recognized Specialist in Swallowing Disorders with over 21 years of experience. She is a senior speech-language pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts, where she is involved in evaluation, treatment, and program planning for adults and children with dysphagia.

Ms. Mansolillo received her Bachelor of Arts degree in communication from Rhode Island College and earned her Master of Arts in speech-language pathology from the University of Connecticut.

Speaker Disclosures:
Financial: Angela Mansolillo has an employment relationship with Elms College and Cooley Dickinson Hospital. She is a consultant with Dysphagia Services and receives speaking honorarium from Education Resources, Inc., HomeCEUconnection.com, SpeechPathology.com, Medbridge, Respiratorytherapy.com, ContinuEd. Angela Mansolillo receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Angela Mansolillo is a member of ASHA.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 7/26/2021
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.0 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Occupational Therapists & Occupational Therapy Assistants - Credit Available Until: 6/30/2025
PESI, Inc. is an AOTA Approved Provider of continuing education. Provider #: 3322. This self-study course qualifies for 6.0 self-study contact hours or .6 CEUs in the Category of Domain of OT and Occupational Therapy Process. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. Course Level: Intermediate.

Arizona Occupational Therapists & Occupational Therapy Assistants: CE credit is available. This self-study course consists of 6.0 continuing education clock hours for Arizona OTs and OTAs. The Arizona Board of Occupational Therapy Examiners (R4-43-203) confirms acceptance of continuing education programs relevant to occupational therapy that are approved by the American Occupational Therapy Association (AOTA).

Florida Occupational Therapists & Occupational Therapy Assistants: PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number 50-399. This self-study course qualifies for 6.0 continuing education credits.

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Speech-Language Pathologists & Audiologists
This course contains 6.0 hours of self-study continuing education. It was not offered for ASHA CEUs. Please retain your certificate of completion. If audited for ASHA Certification Maintenance, you can submit this certificate of completion at that time. For state licensure, teacher certification renewal, or other credential renewal, contact those agencies for information about your reporting responsibilities and requirements.

California Speech-Language Pathologists/Audiologists: PESI, Inc. is an approved provider with the California Speech-Language Pathology and Audiology Board, #PDP 319. This course meets the qualifications for 6.0 hours of self-study continuing professional development credit for Speech-Language Pathologists or Audiologists, as required by the California Speech-Language Pathology and Audiology Board.

Florida Board of Speech-Language Pathology and Audiology: PESI, Inc. is an approved provider with the Florida Board of Speech-Language Pathology and Audiology. Provider Number: 50-399. This self-study course qualifies for 6.0 continuing education credits.

Kansas Speech-Language Pathologists: Approved for 7.0 self-study continuing education clock hours for Kansas licensed Speech-Language Pathologists by the Kansas Department for Aging and Disability Services.

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Other Professions
This self-study activity qualifies for 6.0 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Speech-Language Pathologists, Speech-Language Pathology Assistants, Occupational Therapists, Occupational Therapy Assistants, Respiratory Therapists, Nurses, Nursing Assistants , Restorative Nursing Staff, Dietitians, Dietary Managers, Long-Term Care Professionals