Updates from the World Dysphagia Summit

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on Twitter @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology - Head and Neck Surgery by following @CleClinicHNI on Twitter, that's @CleClinicHNI, on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I'm excited to welcome back Dr. Martin Brodsky, Section Head of Speech-Language Pathology here in our Head & Neck Institute. If you haven't listened to his previous episodes on our podcast, I encourage you to do so. We'd also like to welcome our special guest via Zoom, Dr. Georgia Malandraki, Professor in the Department of Speech Language and Hearing Sciences at Purdue University and Faculty Associate in the Center on Aging and the Lifecycle there as well. Dr. Malandraki is also immediate past-president of the Dysphagia Research Society, who organized this Spring's World Dysphagia Summit. Welcome to you both.

I'd also like to highlight before we dive in that June is Dysphasia Awareness Month, and Dr. Brodsky and Malandraki attended the World Dysphagia Summit, so we're looking forward to hearing their takeaways.

Before we dive into that, let's start by having you both share some background on yourselves for our listeners, where you're from, where you trained, how you came to your current positions, both here at Cleveland Clinic and at Purdue.

Martin Brodsky: So I came here to the Cleveland Clinic in October last year, 2022. Prior to that, I was at Johns Hopkins University for about 15 years, and before that I was in South Carolina Medical University of South Carolina, where I did my doctoral training. Officially graduated with a PhD from the University of Pittsburgh. And I've been concentrating in swallowing and swallowing disorders and moved most recently, probably over the last 10 years into airway injury following extubation in the ICU.

Paul Bryson: Thank you for that. Dr. Malandraki, how about you?

Georgia Malandraki: Yeah, so I've been at Purdue since 2014. Came here as an assistant professor. My area of expertise is in swallowing, neurophysiology and neuro rehabilitation as well as telehealth. And I know we may talk about telehealth a little bit later in the episode. Before Purdue I was a faculty for about three years at Teacher's College, Columbia University. And then before that my training was, my postdoc was at the University of Wisconsin in Madison with Dr. Joanne Robbins, and my PhD was with Dr. Adrienne Perlman at the University of Illinois. I also did my masters at Ohio University in Athens, Ohio. And, and actually that was the, the time when I came to the U.S. Before that, I was in Greece where I did my bachelor's here in Greece, in my home country. And I'm actually here right now. So I'm talking to you from the beautiful island of Crete where I come from.

Paul Bryson: Fantastic. This is an international podcast. So <laugh>, this is, this is great to hear and I hope your travels were good. Wonderful. Excellent. Well, you know, I, I’ve come to understand that the World Dysphasia Summit does not happen every year, and it's a pretty special event, and it's an international event. I know you were both there and Dr. Brodsky has shared with me your leadership role in the meeting. Can you both share some, you know, primary takeaways from the meeting and I guess what's the, what's the latest and greatest being applied to your practices and, and just some of the things that were important to both of you from the World Dysphagia Summit?

Georgia Malandraki: So maybe I can start by saying a, a little, a few words about what the World Dysphagia Summit is, and I'm sure Marty can chime in about some of the highlights too. So the World Dysphagia Summit is typically a two day summit that was organized as a joint effort by three of the largest international societies, the European Society for Swallowing Disorders, the Japanese Society for Dysphagia Rehabilitation, and the Dysphagia Research Society. And the first one was organized and held in Europe, in Barcelona, by the European Society in 2017.

It is a summit that the idea is that we want it to occur regularly, but as you said, not every year. And right now the agreement is that it will be held every three years. The goal is, you know, once so often to bring together the researchers, most of the, you know, most prominent researchers and clinicians across the world, to come together and talk about issues relating to patients across the globe and try to debate, discuss and hopefully find consensus and agreement on what are the best practices, what should be our minimum standards of care for diagnosis and treatment across the lifespan, as well as how, what do we need to do to better understand the mechanism of dysphagia so that we can better diagnose and treat our patients, and what are the innovations that we should be working on.

So that is, that is the, the essence of the summit. And we were very fortunate this past year to organize it as the Dysphagia Society. And, I do want to mention that I was co-chair of the meeting with Dr. Bonnie Martin-Harris. I had the great honor to work with her and the really fantastic planning committee and management company of DRS and the, the last one, the third WDS that was organized by DRS was held in San Francisco, California. So I just wanted to, you know, introduce the summit and the essence of it, it was really a spectacular, we had more than 360 participants from 18 countries, more than 13 disciplines represented from across the world. So it, it was really a unique opportunity for us to come together and discuss about the latest and greatest, and I'm sure Marty can give us more on the details and highlights.

Martin Brodsky: You know, I certainly champion everything that Georgia just said, and the statistics that she just gave you with regard to the countries and the disciplines kind of really puts the exclamation point behind team science and team treatment and assessment everywhere. Dysphagia is this, no one discipline owns it, and the World Dysphagia Summit and all of the societies now around the world, there are several of them, certainly emphasized this interdisciplinary and multidisciplinary work that we're doing. To that extent, this year's conference focused on several areas that I'd like to highlight. The first one was basic translational research. It started us off, and then we moved out to screening and clinical examination diagnostic challenges and case studies, both pediatric and adults. So I, you know, certainly throughout the conference we heard research and experiences through the lifespan. It's not just focused on one patient population at all. Imaging and signal processing, I think was one of the newest things that we had getting to hear all the latest and greatest in technology.

Paul Bryson: You know, to stay along the lines of new technology and AI and wearables. I know that telehealth has become an important feature of, of delivering care, both from a rehabilitative and an evaluative standpoint. Can Georgia and, and Marty, can you give some updates on where do we stand with telehealth? I understand here, at least in the United States, there's, there's been some regulatory and policy changes and I think our individual academies have been, you know, kind of working hard to try to, you know, keep the focus on the patient and patient care.

Georgia Malandraki: Yes, absolutely. Yes, there has been a really big effort since, especially since the pandemic started, even before the pandemic, but I think it has been more intense since the pandemic started to ensure that we can still provide care while at the time mitigating the risks for the virus. And, that actually, you know, COVID created a lot of obstacles with in-person the service delivery, but it also created an opportunity for telehealth service delivery. Because of that, a lot of the, a lot of the regulatory restrictions were lifted or became looser and allowed us to keep providing care for our patients. One of the big obstacles was still, you know, being reimbursed by Medicare and a lot of our associations, especially the American Speech Language, teaming with the American Academy of Otolaryngology-Head and Neck Surgery and other societies really advocated very seriously.

And we were able to cover a lot of our services through Medicare as well through the public health emergency until a few weeks ago. I would say we were alarmed because the public health emergency was set to end in the beginning of May, and it wasn't certain what would happen beyond that time, for a lot of those services that were allowed during the pandemic. But for the time being, the good news is that the services are still allowed and covered by Medicare and other agencies. We are continuing our advocacy efforts so that this can continue beyond the next deadline that they gave, that I believe is December, 2024, if I remember correctly, for most services. So ASHA and, the American Academy of Otolaryngology, again, we are trying to write right now a white paper and try to advocate for permanent coverage, hopefully both the patients and the field and the government will all see how valuable being able to deliver those services has been as long of course, as these services can be done reliably and for the right clinical reasons, and we can keep using telehealth for those patients that it is appropriate for and for those procedures that it is appropriate for.

It's not for everybody, and it's not for every procedure, but it has definitely helped improve access of care for certain patients and certain procedures across the country and across the world. So the advocacy continues and hopefully we, we can have the support of many of the clinicians out there as well.

Paul Bryson: You know, I appreciate that update. As we look ahead to the next year, what are some focus areas for, for yourselves and your colleagues in the field of speech language pathology? Are there any meetings coming up that, that you're presenting at that either of you would like to promote?

Georgia Malandraki: Well, I mean, there's a, a few exciting things that I think if it's okay with you, I would like to share about,  the Dysphagia Research Society organizing. First of all, June being Dysphagia Awareness Month, we have, what is called the Dash for Dysphasia, which is an activity trying to fundraise to support new investigators and become part of the society and be more involved in dysphasia care and dysphasia research dissemination. I do want to mention that the WDS, the March WDS, was professionally video recorded, and it will become available on our website for a lot more people to view in the fall of 2023, in the upcoming months. And then we also have the, the Fall Dysphasia Federal Research Institute for Education Conference, which is a mentoring conference for, again, for young and new investigators and even non-members that may be interested in potentially becoming members of DRS.

And of course, our flagship event is next March is our annual meeting that will be in Puerto Rico. So very fun place and a lot of excitement. It's always the meeting that everybody looks forward going to, because again, the latest of dysphagia research is presented there, and it's really great to see everybody and learn what is new and what is upcoming as well. So those are the main things that I want to highlight from the Dysphagia Society standpoint. There's lots of other things. ASHA is coming up - the American Speech Language Hearing Association - in November as well. So lots, lots of exciting conferences and new areas.

Martin Brodsky: I'll add to the list of things that the Dysphagia Research Society is doing with the DRIs C or Dysphagia Research Society Institute for Education has webinars almost every month. It's about eight, eight times a year on various topics. Always a collaborative approach between typically two speakers. Pretty extensive question and answer session. It's a lot less expensive than any conference you'll attend. CEUs and CMEs are available for these kinds of events, and you'll be able to interact with the speakers very directly through a question and answer session in the chat function. Everything’s held virtually, typically midday and different times each month. So check the DRS website for further details. It's dysphagiaresearch.org.

Paul Bryson: That's great. That sounds like a great resource. As we wrap up, can, can you share any take home messages for our listeners this time? We'll start with you, Dr. Brodsky,

Martin Brodsky: What I would say is, kind of a little bit what I said before is that dysphagia is a team sport throughout the year. There are many offerings with regard to dysphagia. So whether you're attending the World Dysphagia Summit, Dysphagia Research Society, or the American Speech Language Hearing Association's offerings, there are other, less known in this community, but still offer a lot. The American Thoracic Society is one of them. Another one would be Society for Critical Care Medicine, the Society for Neuroscience, the American Academy of Otolaryngology-Head and Neck Surgery in the COSM meeting has many offerings with regard to dysphagia. So it's not just these things that we've been talking about here, it's worldwide as well. You've got the European societies, you've got, even within Europe, you have the different countries like the Irish Society for Swallowing Disorders and other places around the world. Mexico is another one.

So the bottom line here is take a look around you and see what's available, what's happening in each of these societies. You're going to find exactly the same kinds of mixes that you will at every other conference in that you're going to see many disciplines. It's not just one or two. And that's what I think brings a lot of innovation, a lot of creativity, a lot of excitement for me as both a clinician and a researcher to be able to see the interactions of everybody at these meetings and the discussions that occur even between the meetings.

Paul Bryson: Yeah, appreciate that.

Georgia Malandraki: Yeah, and I would, I would, uh, completely agree and I would build on what Marty said and say that especially for dysphasia, you know, in the clinical real of things, we are a relatively young profession, clinically at least. So we are still learning so much. So working together across disciplines is the best way. And being open to working together is the best way to really learn more from each other about the mechanism and about how to best diagnose and treat it. And we're still a young clinical profession, and we need to be open to these collaborations and open to, to new innovations and new developments as well. I think one of the things that holds back our profession sometimes is dogmatism and being very, you know, stuck on one or another method without necessarily having the evidence behind it. So I think it is, it is important to understand how young our field is and how important it's to keep learning from each other so that we can serve our patients the best way possible.

Paul Bryson: Yeah. Excellent points. It's so true. I think we have to remain open, you know,

Georgia Malandraki: Exactly. <laugh>.

Paul Bryson: Well, for more information on speech therapy at Cleveland Clinic, please visit clevelandclinic.org/speechtherapy. That's clevelandclinic.org/speechtherapy. And to speak with a specialist or submit a referral, please call 216.444.8500. That's 216.444.8500. Dr. Brodsky and Malandraki, thanks for joining Head Neck Innovations.

Martin Brodsky: Thanks for having us.

Georgia Malandraki: Thank you for having us. Thank you so much.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website at clevelandclinic.org\podcasts, or you can subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.