Aug 30, 2014 - step-by-step instruction for the evaluation and treatment of patients receiving the MDTP approach. Protocols for MDTP. Step by Step. What is MDTP (McNeill Dysphagia Therapy Program)?
For those of you who haven’t heard of the McNeill Dysphagia Therapy Program or MDTP, you need to look it up. You can Google search the supporting evidence of the program. I have been extremely excited about this course since I’ve heard about it 3 years ago. The downfall, it’s only offered at certain times. The limitation of the course prevented me from attending for a while, however this January, I had the opportunity to attend in Orlando. In 2010, I attended the ASHA convention in Philadelphia. I went to a session by Dr.
Carnaby and Dr. Crary talking about MDTP. Of course, it was mostly discussing the research and success behind the technique. It was interesting though to see that the results they found with this therapeutic technique indicated superior outcomes to traditional therapy alone. At first, I was a little uncertain why there was so much secret behind this therapy. When you go to the course, you have to sign a contract that you won’t teach the technique to anyone else.
Also, to use this technique and call it MDTP, you must be certified. If the therapy is so great and successful, why not share it with everyone?? In talking to the researchers, Dr. Carnaby and Dr. Crary, they want to make sure that SLPs are properly trained in this technique before going out and attempting it with their patients. They want to train the SLPs in the technique.
The technique makes sense. In providing services for over 10 years, one thing has become very prevalent in our services. We have increased our understanding for neuroplasticity and exercise-based therapy programs. When we look at neuroplasticity, we must use specific tasks to increase the swallow. If I want a person to run a marathon, they have to run. Sitting on an exercise bike daily will not get them prepared for the marathon without actually practicing running.
If I want my patient to be really good at sticking out their tongue, that’s what I’ll have them do. I want my patients to improve their swallowing, so that’s what I need to target with my patients. MDTP is a systematic exercise based program, focusing on swallowing using exercise principles.
While I am not allowed to teach the specifics, or include them in this post, the basics and concepts of this approach are freely available in the articles that can be accessed through Google. We can learn a lot through our PT/OT counterparts. They work the muscle systems through exercise based therapy using weight and resistance to increase the motoric output of the muscular system. This is what we should be doing.
While we can’t necessarily add weights to the swallowing muscles, we can use food and the bolus as resistance and weight. We have the effortful swallow available using a higher resistive swallow with our patients.
SEMG can be utilized to get the patient to swallow harder and to monitor their swallows. So many of us have learned therapy the old way. The stick out your tongue 10 times way. That’s how I learned. Naturally, there was little carry-over, little improvement and a lot of patients wondering what in the heck we were even doing. I have had my first new patient since learning MDTP. This is an NPO patient with a feeding tube.
Traditional therapy to increase the muscles of the swallow has not worked. Two MBSSs later, the patient is still NPO, with occasional ice chips and drinks of water. During our first session, the patient went through the first 4 levels of MDTP.
NMES was introduced during the session, as patient had to swallow 5-6 times to clear the bolus. NMES combined with MDTP reduced the number of swallows per bolus to 1-2, occasionally 3. MDTP finally focuses on swallowing as a whole. It gives us a protocol with a food hierarchy, a specific swallow, a program to follow and a pass/fail criteria. It forces us to look at the muscle function, how the muscles are made, what we can do to change the muscles, after all, we are rehabilitating our patients.
I highly recommend this course to anyone and everyone treating patients with dysphagia. The information regarding muscles, therapy and neuroplasticity is invaluable and great review if you are familiar with the content. The technique is phenomenal with no materials, tools or expensive equipment to buy. You can take the 1 day course and utilize it the next day. In our therapy world where outcome based therapy is becoming essential for reimbursement, MDTP gives us a way to measure outcomes for our patients.
More importantly, MDTP works. Not for everyone, unfortunately there are those we just can’t help.
Our patients though deserve and expect the most recent, successful therapy processes we can provide. Our patients success is why we do what we do.
If you are interested in MDTP, course information is available at. Like ProCourse on and follow them on.
Filling out the confidentiality and non-compete agreement at the beginning of the course dulled some of my enthusiasm. Initially, I felt a surge of irritation. If this treatment is so important, then why not share it?
This thought was quickly leavened with the realization that all healthcare companies and device manufacturers operate under this legal umbrella of secrecy. Devices are patented because they make money. No one gets angry at GE because they don’t make new imaging technology free and available to all hospitals.
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We shouldn’t, then, get too upset when a new, research-based, program is also guarded. I would hope, however, that as this course spreads in popularity (I believe it will) that it will become available for purchase in different formats other than small lecture based presentations.
A web-based video course with reviews could easily be set up, and people could pay a reasonable fee to access it. It also wouldn’t hurt my feelings if more information was just shared freely, but I’ll try to temper my idealism. Given my constraints, I’ll make sure and talk about the McNeil Dysphagia Therapy Program (MDTP) in general terms, and I’ll try to comment specifically on the quality of the conference itself. While I would have much preferred the next location this seminar was being conducted at (Europe) to Jackson, Mississippi, I was pleased with the conference room and all of the other administrative details of the conference.
Also, ProCourse CEUs has a good point of contact with Cindy Barnett. She has always been easy to get in contact with, and was very helpful with the last CEU course I took on FEES through ProCourse CEUs. I know that I can expect to have the paperwork end taken care of without issue, and if there is a problem I know that Cindy can help me with figuring it all out. As to the content of MDTP, I must be rather circumspect in what I say; so, I’ll lay out some bullet points to describe the therapy without going into too much detail:. It is definitely based on solid research (Randomized Clinical Trials). It does not purport to be a panacea for all dysphagia patients. It can work as a stand alone therapy or with other treatments (NMES, Biofeedback via sEMG, etc.).
It was much more than I expected, given the fact that it is largely based on exercise physiology, and I felt my knowledge base in this area was “pretty good”. In my opinion, it is a true paradigm shift in terms of dysphagia treatment. Even if I decided that this program wouldn’t work for many of my patients, I would still have learned a couple of really important clinical ideas (e.g.- reliability and validity are research terms that we all need to re-acquaint ourselves with due to their relationship to things like jobs and reimbursement, and it’s important to start identifying the clinical indicators that accompany aspiration during MBSS/FEES so we can note those during treatment). The big question after any conference I’ve gone to is, “Was this worth the money and time?” In short, yes. I believe the information is solid and based on well thought out research. They manage to make connections to things that will challenge and delight you. The proof, as always, is in the pudding.
I won’t really know for sure how well this works until I’ve used the therapy on a few of my own patients, but given the rigorous data supporting MDTP and the ease of access to its creators, (Dr. Giselle Carnaby and Dr. Michael Crary gladly gave me their email addresses for follow-up questions) I feel confident that I’ve stumbled across a new, exciting way of looking at how I approach the treatment of many of my patients with dysphagia.
In regard to this specific therapy approach (and likely in general as well) you want to be able to identify possible aspiration events while doing therapy. For example: coughing (do they cough when they aspirate/penetrate or do they cough excessively as a maladaptive bx), facial grimace with aspiration, throat clearing = aspiration with some patients, watery eyes may be a good measure of an aspiration event in others, but without data from the eval we will be left to simply guess. Also, I always appreciate knowing what’s really at the heart of the dysfunction (e.g.- weakness and where, dyscoordination, poor awareness, abnormal swallow pattern, etc.). I feel like I’m leaving important things out. If anyone else can think of other key features that they like to see in the report, chime in!