Christler & Associates PLLC

        ANDREW CHRISTLER MA,CCC-SLP

SPEECH - LANGUAGE PATHOLOGIST

DIRECTOR OF EDUCATION & DEVELOPMENT

CLINICAL TRAINING SPECIALIST

CORPORATE COMMUNICATION TRAINING SPECIALIST

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Biography

Andrew Christler MA,CCC-SLP is a speech-language pathologist with 15 years experience working in the areas of voice and swallowing. Before graduate school Andrew worked as a Disc Jockey and Radio Personality. He earned his master's degree from Wayne State University in Detroit, MI in 2005. He has presented, in both English and Spanish, domestically and internationally in the areas of the professional voice user, manual therapy techniques, diagnostic instrumentation (FEES, MBS, & Videostroboscopy) and mirror neurons. He has worked in pediatric feeding and swallowing disorders in Palm Beach County Public Schools and online with presencelearning.com. He served as the clinical director for MedSpeech inc for more than 8 years. He is currently  professor emeritus of dysphagia, telerehabiliation, intregrated practicum and bilingual diagnostics/interventions at the University Manuela Beltran in Bogotá, Colombia. Andrew acheived a convalidation of his titles to become a Fonoaudiologo (FLGO) in 2016. He was the coordinator of myofunctional therapies and feeding/swallowing disorders for IPS Yenny Salozar/Goleman for all their sites in Colombia. He is currently based in New York City and travels nationally and internationally as a clinical instructor for SEC Medical Speech Pathology. As the new Director of Education and Development for SDX Swallowing Diagnostics www.sdx-fees.com, Andrew places a practical approach to educating SLPs, nurses and administrators. He combines new theoretical knowledge with clinical practice.

 

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Andrew Christler M.A. CCC-SLP

 

Speech-Language Pathologist

Pediatric and Adult

Voice, Swallow, Airway Specialist

Tracheostomy Specialist

Clinical Instructor

Clinical Training Specialist in FEES, Videostroboscopy and MBS

Director of Education and Development

Advanced Training in Corporate Communication

Innovative Training in Sales Communication

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Andrew is a wealth of knowledge and experience in the area of Speech-Language Pathology.

 

RELEVANT WORK EXPERIENCE

  • ·       Director of Education and Development - Regional Director for NY & NJ, SDX - FEES (2017-Current)
  • Owner/Director: Christler & Associates, Private Practice (2014-Current)
  • ·       Clinical Instructor (National & International) for FEES, Videostroboscopy, & Tracheostomy care: SEC Medical, Boston MA (Current)
  • ·       Senior Speech-Language Pathologist (LTAC): Kindred Hospital, West Palm Beach (January 2017-September 2017)
  • ·       Voice/singing/stuttering expert in residence. Former Director of clinical services, MedSpeech Inc. www.med-speech.com (2009-2017)
  • ·       University Professor: Universidad Manuela Beltran, University Professor teaching Dysphagia and Practicum, Bogota Colombia (2015-2016)
  • ·       Pediatric Dysphagia Program Coordinator/Educator: La Clinica Goleman, Bogota Colombia (2015-2016)
  • ·       Accent modification expert (Consultant), Darlington English Consultants, Bogota Colombia (2014 – Current)  
  • ·       International Mentorship coordinator for Speech-Language Technicians via telecommunications, Faridabad,India  (2014-Current)
  • ·       Telehealth Specialist in Speech-Language Pathology, www.presencelearning.com (August 2014- August 2015)
  • ·       Director of clinical services and voice/singing/stuttering expert in residence, MedSpeech Inc. www.med-speech.com (2009-2017)
  • ·       Pediatric Swallowing expert and aggressive/violent behaviour expert, Palm Beach Public Schools. (2008-2014)

  • ·       Officer/Secretary Voice, Airway, Swallow Center, A not for Profit organization.  Conference organizer and lecturer (2009-2015, 2016-2017).
  • ·       Pediatric pragmatic language expert, Palm beach county public schools, (2010-2013)
  • ·       Clinical Supervisor for externships, American Speech/Langauge Hearing Association, (2007-Current)
  • ·       Guest instructor/Introduction to Communication Sciences/Neurological Sciences, Florida Atlantic University, (Fall 2012)
  • ·       Voice and tracheostomy/ventilator dependent expert, Wellington Regional Medical Center, (2011-2013)
  • ·       Pediatric language disorder specialist, ASD & atypical language patterns, Supplemental Healthcare, (2005-2011)
  • ·       Tracheostomy/ventilator/airway swallowing specialist, Supplemental Healthcare, (2005-2011)
  • ·       Quality Assurance SLP Specialist, Supplemental Healthcare, (2005-2008).
  • ·       Lead Diagnostician and Cleft Palate/airway specialist, Children’s Hospital of Michigan. (2005-2008)
  • ·       Clinical Fellowship with a focus in acute/subacute/Trauma/instrumental diagnostics, Henry Ford Hospital in Detroit, MI (2004-2005)
  • ·       Disc Jockey, Sound Productions Entertainment, Most Requested DJ in the Midwest 3 years running. (2001-2008)
  • ·       Director of homeless children’s summer programming, Cass Community Social Services, (1999-2003).
 

Education

M.A. Speech-Language Pathology
Wayne State University
2005

Certificate of Clinical Competency

Speech-Language Pathology
American Speech-Language Hearing Association
2006

B.A.A. Communication Disorders & Nutrition
Central Michigan University
2003

Convalidation of Titulos in Fonoaudiologia in Colombia
Ministry of Education Bogota Colombia
2016

NATIONALLY CERTIFIED IN

SPEECH-LANGUAGE PATHOLOGY

STATE LICENSES INCLUDE:

NY, NJ, FL, CA

 

Skills & Languages

  • 20 years of interactive and engaging public speaking.
  • 15 years experience using innovative techniques to engage audiences. Training lawyers, sales professionals and executives to understand corporal communication, identify its meaning and alter their approach to gain success in every setting.
  • 14 years experience in Specialty Areas —Adult and Pediatric Voice, Airway, Stuttering, Swallowing and Neurogenic Disorders
  • 10 years experience Extensive experience with instrumental diagnostic tools, advanced diagnostic and treatment skills. Use only cutting edge diagnostic and treatment options. FEES, Videostroboscopy, Modified Barium Swallow Studies
  • Speaks 3 langauges: English, American Sign Langauge, and Spanish
  • University Professor instructing in Dysphagia and acute care practicum.
  • Instructor for international conferences and trainer on the use of videostroboscopy and FEES as a diagnostic and treatment tool.
  • Instructor for international conferences on the effects of medication on swallowing and voice.
  •  Instructor for national/international conferences on Trach/Vent 101 for the Speech-Pathologist
  • Ability to reduce costs and lengths of stay in ICU/acute and subacute settings for patients with chronic cough, recurrent pnuemonias and aspiration pneumonias.
  • Initiatives and successful dysphagia program growth
  • Reduce healthcare costs in patients with: COPD, GERD, Asthma, Tourettes syndrome, CVA/TBI.
  • Rehabilitation and return of normal function in patients depended on: PEG tube feedings, Tracheostomy/Ventilator.
  • More than 10 years experience as a diagnostician in acute, subacute, and outpatient facilities.
  • More than 7 years in public school systems/Pediatric Dysphagia.
  • Consulting on pediatric swallowing, trach/vent, speaking valve for use in the public schools and in home healthcare.
  • Extensive knowledge of medicare, Medicaid and private insurance rules, related to outpatient and telehealth practices.
  • 22+ years experience working with children and adults with mental illnesses.
  • Extensive experience writing, planning and implementing Individual Education Plans (IEP).
  • View patient care as teaching and learning in a dynamic and interactive process. A holistic view of patient care and team healthcare management.
  • Advanced clinical specialist in behavioral aerodigestive care with a focus in acid reflux {GERD} and ph probes
  • Instructor/Mentor/Supervisor in clinical education for ASHA CFY, University Internships.

English

Spanish

American Sign Language

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Persuasive Communication in Corporations.

Value centered organizations are investing in senior communications roles for the long-term and specialized training to give them an advantage. Communications professionals can be beneficial in terms of knowing the product or services. Industry knowledge is no longer enough to be an effective communicator in today's client focused environment.

As an expert in voice and nonverbal communication, a highly specialized speech pathologist will give a unique perspective on this skill set. Fundamentally, basic neurology drives communication and relationship building.  Innovative training to instruct speakers about engaging with clients, communicating beyond emails, understanding the nuances that their audience is sending non-verbally and adapting to maintain an active relationship is crucial. Changing behavior, language and appearance can transform a negative into a positive experience in the work place.  A lawyer needs to gain confidence of their jury. A salesman builds a relationship for return purchases.  The ability to identify when and how to engage with a client is paramount to building a successful relationship.

SWALLOWING DISORDERS

You may hear your healthcare worker or speech language pathologist refer to your swallowing disorder as dysphagia (dis-FAY-juh). Dysphagia is the technical term for impaired ability to move food from the mouth to the stomach. During a normal swallow, food is put into the mouth, chewed thoroughly, then pushed to the back of the mouth by the tongue. The food then leaves the mouth and enters the pharynx (common pathway for food and air), where the brain triggers an involuntary swallow reflex (pharyngeal swallow). A series of muscle contractions push the food through the pharynx and close off the airway (trachea) so no food enters it. This part of the swallow lasts less than a second, so timing is very important. The food then enters the esophagus (food tube) and muscle contractions push the food down into the stomach. Breakdown anywhere along this pathway can result in swallowing difficulty.

VOICE DISORDERS

There are many types of voice disorders and many causes. A voice disorder is usually noted by a change in the voice quality such as chronic hoarseness, roughness, breathiness, or pain in the throat. If an individual has chronic hoarseness or vocal change for more than 2 weeks, he/she should contact their health care professional, a physician or a speech language pathologist.

The following are some of the most common voice disorders and their causes:

Vocal fold paralysis: one or both of the vocal folds do not move properly towards or away from midline due to paralysis or weakness of the fold(s). The cause may be damage to nerves during surgery, tumors pressing on the nerve, accidents causing damage to nerve or vocal fold muscle, or idiopathic infection.

Vocal fold nodules: benign lesion that is usually on both vocal folds and varies in size. They are usually caused by trauma or inflammation of the vocal folds from voice abuse (smoking, yelling, loud/excessive talking, improper breathing, throat clearing, and coughing) over a period of time.

Vocal fold polyps: fluid filled lesions that usually appear on one vocal fold only. They usually appear suddenly from one incident of voice trauma or abuse.

Polypoid degeneration: swelling along the length of the vocal fold. This is usually caused by chronic misuse of the voice related to abuse and smoking.

Vocal fold dysfunction (AKA, paradoxical vocal fold motion and proximal laryngospasm): inappropriate closure of the vocal folds during inhalation. This may be confused with respiratory difficulties such as asthma and individuals may be inappropriately intubated if VCD is not properly differentiated.

Spasmodic dysphonia: vocal folds appear normal until they are used for talking at which time the movement becomes uncontrolled and spastic resulting in tight, quivery, and hoarse voice with periods of no sound. The cause is unknown.

Fluency

Fluency Disorders/Stuttering/Cluttering

“Fluency disorder” means the interruption or repetition of sounds, syllables, and words; prolongations of sounds; avoidance of words; silent blocks; or inappropriate inhalation, exhalation, or phonation patterns. These patterns may also be accompanied by facial and body movements associated with the effort to speak. Our experts have decades of experience working with people who stutter. We are well versed in differentiating normal childhood disfluency versus a true fluency disorder.

Pediatric Speech/Language & Swallowing/Feeding Disorders

Every aspect of communication from articulation to language and Pragmatics. Articulation is the specific speech sounds and how the sounds are formed. Language are the words used and how they are organized into sentences. Pragmatics is social skills.

Pediatric feeding include Tongue Thrust, Disorders of chewing and swallowing. Impairments may be due to low/high tone or hypotonia/hypertonia, tongue tie or Ankyloglossia, or dental/orthodontic concerns. All of the above are treated with behavior and manual therapy techniques. Orofacial Myology specialists treat all of these disorders.

 

GERD/LPR

Gastro-esophageal reflux occurs when there is retrograde flow of gastric material into the esophagus. When stomach contents pass into the esophagus in excess, there can be tissue damage with possible symptoms of heartburn and regurgitation (Dent et al., 2001).  As a clinician working for the past 17 years with dysphagia patients who have Gastro-esophageal reflux disease (GERD), I have a unique appreciation and understanding of this condition, as it is something that I have myself and must deal with on a daily basis.

If left untreated, GERD can result in various conditions in the esophagus including Barrett’s esophagus, where the tissue lining the esophagus changes and is replaced by tissue more like the type found in the intestinal lining. Barrett’s esophagus may also place some GERD patients at a higher risk for esophageal cancer if left untreated (Drewes et al., 2011). In clinical practice of performing modified barium swallow (MBS) on a regular basis, the presence of reflux in the esophagus can be seen at time on MBS. A physician is required to provide the medical diagnosis of GERD.

GERD & LPR

One area commonly seen during flexible endoscopic evaluation of swallowing (FEES) and also on MBS exams in clinical practice is Laryngopharyngeal reflux (LPR). This condition is one of the extra-digestive manifestations of GERD and occurs when there is retrograde flow of gastric contents into the pharynx and the larynx ( Martinucci et al., 2013). LPR is more typical of the “reflux” that may result in a burning sensation in the throat. This also requires a physician to render a medical diagnosis.

As a member of a multidisciplinary team in an outpatient setting, the management of both LPR and GERD commonly involves input from the primary care physician, the otolaryngologist, the speech language pathologist, the gastroenterologist, and at times, the pulmonologist if there are pulmonary symptoms related to the reflux. In this multidisciplinary format, the diagnostic testing done by the speech language pathologist, whether it is FEES or MBS, is involved as a part of a battery of exams, in the decision making process for patient care by the physicians, when it comes to managing reflux.

The flexible laryngoscopy is performed to assess for changes in the laryngeal and pharyngeal anatomy related to reflux: edema, erythema, masses, and ulcerations. Following the exam, the team can refer to the speech language pathologist for a FEES to help determine if there is pharyngeal dysphagia component to the reflux and to determine if there is retrograde flow of material from the esophagus and into the larynx and pharynx. This may also involve an outpatient MBS to be done by the speech language pathologist, depending on the symptoms the patient is reporting. Typically, otolaryngologists show preference for LPR patients to receive FEES and GERD patients to have an MBS.

Sensory testing can be done with flexible endoscopic evaluation of swallowing with sensory testing (FEESST). The FEESST exam can be done by a speech language pathologist with specialized training. Some patients with LPR have increased edema in the area of the arytenoid cartilage and the surrounding anatomy. This is some of the anatomy in closest proximity to the UES, which is the point of entry for LPR. FEESST involves air pulse testing just anterior to the arytenoid cartilage along the aryepiglottic fold. This is an area of innervation of the internal branch of the superior laryngeal nerve, the sensory nerve for the supra-glottic space.

If gastric acid injury has caused edema of the laryngopharynx, the intensity of the FEESST air pulse required to trigger the laryngeal adductor reflex (the airway protective reflex) may be greater in patients with acid-induced laryngeal swelling (Aviv et al., 2000). Patients who then receive treatment for their reflux can then be re-evaluated after 8-10 weeks to help establish if sensory testing scores may have improved and to also visualize the reduced edema in the laryngopharynx.

During FEES, it is possible for the speech language pathologist to visualize secretions and/or PO bolus intake having retrograde flow through the UES, from the esophagus to the laryngopharynx. Then, the speech language pathologist can report back to the otolaryngologist and can recommend work-up for reflux. When stomach contents enter the throat, it can result in potential tissue damage. LPR patients typically have symptoms of throat clearing, wet voice, frequent cough, throat discomfort during the swallow, vocal quality changes, globus sensation, and foreign body sensation in the throat.

Depending on the findings after FEES or MBS exam, reflux can be assessed while viewing the esophageal phase of the swallow with barium if needed to assess for dysmotility, strictures, masses, and reflux during an esophagram done with a radiologist. While this is done radiographically, the otolaryngologist can assess esophagus endoscopically with Trans-nasal esophagoscopy (TNE). This is often used for patients with LPR that have reflux and dysphagia symptoms despite using anti-reflux medication. The TNE is done without sedation (Chung et al., 2014).  When there is not an LPR component suspected, there is another method of assessment: esophagogastroduodenoscopy (EGD). Similar approach to TNE, but the patient is sedated, done through the mouth with a wider endoscope. It is widely accepted practice that most EGD are performed by gastroenterologists. Our otolaryngology practice has recently started performing ph-probe testing. This exam lasts 24 hours and records the amount of gastric reflux events into the esophagus and monitors how long the reflux remains in the esophagus. The patient also records their symptoms of reflux throughout the 24-hour period (Musser et al., 2011).

The role of the SLP in the diagnosis and treatment of GERD/LPR is critical in the work-up for gastric reflux disease. The treatment team feels that some level of objective instrumental testing by a speech language pathology involving the pharyngeal phase of the swallow should be done. Through collaboration with the physicians, the patient can have a thorough assessment in a team format, as often with GERD and LPR, more than one exam is required to truly capture the symptoms.

 

 

 

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Features Overview

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Testimonials

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Contact

Andrew Christler M.A. CCC-SLP

Owner & Director of Christler & Associates PLLC

(313)421-2166

speechtherapies@yahoo.com

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