The+team

=Multi-disciplinary Team=

====Dysphagia as a disorder consists of many different facets. For a patient to receive the most comprehensive care it is necessary for lots of different professions to be involved with their care. As a professional this means collaborating with other professionals.====

Below is a list of professions who you may come across or work beside while working with a patient in the COPD population.



 * Nursing Staff
 * Dietitian
 * Physiotherapist
 * Occupational Therapist
 * Radiographer
 * Physician/GP
 * Medical Team
 * Speech Language Therapist

Nursing staff will be working closely with patients who are in hospital. Nurses will provide feeds for those who are on non-oral diets (Langley, 1987). As patients with COPD may have tracheostomy tubes there is a high probability of working closely with nursing staff.
 * Nursing Staff**

The dietitian is responsible for assuring the patients caloric demands are met, food and drug interactions are optimum and that they create appetizing meals (Logsdon, 2002). They are also responsible for assuring that patients who are non-orally fed fulfill their recommended dietary intake and that their weight is monitored (Langley, 1987). If weight fluctuates, especially when weaning patients who are tube fed, it is their responsibility to determine where the patients diet is lacking.
 * Dietitian**

Physiotherapists provide support and rehabilitate people whose mobility and participation in life has been affected due to a disability (Physiotherapy New Zealand, 2010). They also have a specialty role with patients who suffer from a pulmonary disease. The physiotherapist is required to treat a patient with respiratory disease daily to help clear the patients lungs (Langley, 1987). They will also advise on all therapeutic techniques to ensure the patients safety.
 * Physiotherapist**

Similar to the Physiotherapist, the Occupational Therapist is interested in the mobility of the patien. However, their focus is on the fine motor abilities of the patient, especially manual feeding skills (Langley, 1987).
 * Occupational Therapist**

The radiographer is responsible for operating the machinery involved with videofluoroscopies. Patients with COPD are often referred for a videofluoroscopy as their presenting dysphagia symptoms occur during the pharyngeal stage of swallowing (Good-Fratturelli, Curlee, & Holle, 2000). As these involve internal structures it is not always possible to perform a comprehensive assessment at the bed-side. Also, patients with COPD are prone to silent aspirations (Coelho, 1987). Using a videofluoroscopic assessment will highlight if this is a factor in a patient's dysphagia.
 * Radiographer**

A patient's physician will have their complete medical history and are able to provide indepth knowledge of the patient's symptoms (Johnson & Jacobson, 2007). It is also important to reciprocate information gathered from clinical and instrumental assessments. When relaying information to the physician it is important to remember that they are not trained in the area of swallowing (Johnson & Jacobson, 2007). A full explanation of case history is required.
 * Physician/GP**

For patients with COPD the medical team could include a Gastroenterologist and Pulmonologist (Johnson & Jacobson, 2007). A Gastroenterologist would be part of the team if the patient was affected by GERD. COPD has a high correlation with GERD (Casanova //et al.//, 2004) so a Gastroenterologist would be required to treat the symptoms. Another member of the medical team may be a Pulmonologist. A Pulmonologist is a specialist who treats conditions of the lung (Health Communities, 2000). As COPD is a respiratory disease the Pulmonologist will have specialised knowledge about how COPD presents and the effects it can have on the patients.
 * Medical Team**

Speech Language Therapists have specialised training in swallowing so are often the lead worker in a dysphagia team (Langley, 1987). They will be responsible for performing the clinical and instrumental assessments and determining the management of the patient's dysphagia.
 * Speech Language Therapist**


 * References**

Casanova, C., Baudet, J., Velasco, M., Martin, J., Aguirre-Jaime, A., Torres, J., & Celli, B. (2004). Increased gastro-oesophageal reflux disease in patients with severe COPD. //European Respiratory Journal, 23, 841-845.// Coelho, C. (1987). Preliminary findings on the nature of dysphagia in patients with Chronic Obstructive Pulmonary Disease. //Dysphagia, 2, 28-31.// Good-Fratturelli, M., Curlee, R., & Holle, J. (2000). Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. //Journal of Communication Disorders, 33, 93-110.// Health Communities. (2000). //What is a Pulmonologist/Pulmonary Specialist?// Retrieved from [] Johnson, A., & Jacobson, B. (2007). //Medical Speech-Language Pathology.// New York, NY: Thieme Medical Publishers, Inc. Langley, J. (1987). //Working with Swallowing Disorders.//Oxon, UK: Winslow Press Ltd. Logsdon, B. (2002). Creating the dream dysphagia team. //Advance for Physical Therapy and Rehab Medicine, 11(11), 55.// Physiotherapy New Zealand. (2010). //What is Physiotherapy?// Retrieved from []