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  • Danni Welch, M.S. CCC-SLP

Happy New Year! Recipes, ArkSHA, Case Study, and more 😊


January… And now let us welcome the New Year Full of things that have never been. – Rainer Maria Rilke I am sending out best wishes for your 2022! ArkSHA Convention 2022 is coming up! Mark your calendars Oct 12-14 2022! Here is the link to join: https://www.arksha.org/index.php/join-arksha

Also, please send over an email to Danni@mobilefeesnwa.com with any ideas about convention in general or topics you would like to see covered. I am working on the speaker line up so if you know someone or have taken a course you loved please send that over to me as well.


FEES Case Study This patient was recently at a local IPR and had an MBS which revealed penetration but no aspiration. He had been hospitalized following a fall, resulting in C Collar and G tube placement. MBS findings stated:
  • Pharyngeal stage dysphagia resulting in penetration of all consistencies tested

  • Frank aspiration was not observed during limited intake of food/liquid trials used in testing

  • No compensatory strategies were attempted during MBS completed while at IPR

MBS recommendations:

  • Continue NPO with all nutrition, hydration, medications.

Fast forward to 18 days later… we were able to complete a FEES once the patient was referred to Amedisys Home Health. FEES revealed that patient had a SEVERE case of thrush which was impacting swallowing function related to edema which directed the flow of the bolus over the left aryepiglottic fold into laryngeal vestibule. Pt did sense the penetration during the FEES and attempted to throat clear. I called it a ‘whimpy” throat clear and we were able to train him during the FEES to produce a stronger throat clear and re-swallow which was effective at clearing the penetration from the level of the anterior commissure. Pt also had a prescription for medication for GERD but he was not currently taking it. Significant s/s of Laryngopharyngeal Reflux were visualized during the procedure including retrograde backflow of bolus from the esophageal inlet as well as severe edema and erythema. The treating SLP was amazing and able to call the PCP’s Nurse and alert them of the issues found during this FEES and facilitate finding the medication that the patient had in the home for GERD already but was not aware he needed to be taking. Education and biofeedback with the FEES video and throat clear, re-swallow technique was crucial in carry over of the technique which allowed this patient to progress to thin liquids (1/2 tsp sip sizes from open cup) and soft foods with added moisture. Another note about this, it is highly likely that this patient was having reflux with tube feeding as well. Keeping this patient NPO does not prevent possible aspiration of refluxed material and thrush cannot be identified with MBS so FEES was truly a game changer for this patient. Images with descriptions from FEES report:

Mission and Vision Statements Therapists In Motion and Mobile FEES Swallow Diagnostics was founded to serve patients who might otherwise fall through the cracks in the system. After working in SNFs, Home Health, and Acute care settings for over 16 years as an SLP, our founder, Danni Welch, MS CCC-SLP, was inspired to open a private practice and a mobile FEES company to increase access to swallowing instrumentation and home therapy focusing on holistic, patient centered, and cutting-edge therapeutic techniques. We began Therapists In Motion with the question, can a therapy company be profitable and do what is right for the patient? We are still in business two years later which feels like an amazing accomplishment given the climate in healthcare and pandemonium AKA pandemic. More importantly, we are able to help many patients who would not otherwise be able to receive therapy due to transportation and mobility issues. If you have a patient that needs ongoing therapy following discharge from Home Health Part A or is discharging to home from SNF and does not need skilled nursing you can refer the patient by calling 479-222-1425 or emailing danni@therapistsinmotion.com. We offer physical, occupational and speech/swallowing/cognitive therapy. We are in network with BCBS of AR, Ambetter, allwell, AR totalcare, traditional Medicare and AR / Ok Medicaid. We are in process with multiple other commercial insurances in AR and OK. Feel free to reach out with questions regarding potential referrals or resources for your patients. Mission Statement: To provide evidence-based, functional outpatient rehabilitative services and swallowing instrumentation by filling the gap in services for those in need. Vision Statement: To become the most effective, ethical outpatient therapy and FEES provider in the country, providing services to all in need when at all possible. I am so excited to share plans and goals for the upcoming year. I am still in the process of pulling everything together so once I get caught up I will share. Please share yours with me too! I love hearing from you all and sharing in your successes! If there is something we can do to help out or if you need assistance in beginning the process of initiating a FEES program in your building you can simply reply to this email and we will begin working with you and your team to get started! I hope you all have a wonderful week and stay warm out there! Sending blessings to all of you, your families, and work families in 2o22.

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