Adult Speech & Swallowing SIM

Question 1

Intro when I first meet with my client online

Answer 1

Hi, My name is Suzy, I’m a student speech pathologist and I’ll be assessing the functioning of the muscles and nerves in your face, and then having a look at your speech and swallowing. When I’ve finished, I’ll be discussing the results with my clinical educator. Is that OK with you?

Question 2

Wrap up when finishing:

Answer 2

Thank you for your time this morning. I will have a look at all the information I’ve collected this morning and discuss it with my clinical supervisor, and we will get back to you as soon as possible with some recommendations. Do you have any questions? OK, goodbye.

Question 3

Before starting Clinical Swallow Exam Tool (Bradfield)

Orientation to situation, place, time, date

Answer 3

*What is the time?
*What is the date?
*Where are you right now?
*Can you tell me why you’re having this assessment?
Are you OK for me to examine your cranial nerve function and your swallowing today?

Question 4

Before starting Clinical Swallow Exam Tool (Bradfield) Ask about meds:

Answer 4

*Can you tell me what medications you are on at the moment?

Question 5

Before starting Clinical Swallow Exam Tool (Bradfield) Ask about breathing:

Answer 5

Listen to breathing - respiratory status.

*How is your breathing feeling? Has it changed at all since (the incindent/youur stroke/recently)?

Question 6

Before starting Clinical Swallow Exam Tool (Bradfield) Ask about dentition:

Answer 6

• Can you please get nice and close to the camera and shine the torch in your mouth:
• Do you have your own teeth, or do you have dentures?
• Are your teeth in good condition, or are they cracked, painful or do you have cavities?
• Do your dentures fit wall?
• Do you have any pain, redness or soreness on your tongue or inside your cheeks?

Question 7

Before starting Clinical Swallow Exam Tool (Bradfield)

See if they can follow 3 single step instructions:

Answer 7

1. Can you touch your nose
2. can you look up?
3. can you shrug your shoulders?

Question 8

7. Is Jaw symetrical at rest?

Answer 8

Can you look straight at the camera for me, but keep your face relaxed. I’m just checking to see that it all looks nice and symetrical. Good…

Question 9

8. Does jaw movement feel smooth when Px opens/closes mouth?

Answer 9

Now can you open and close your mouth. Can you do it again a little bit wider for me? Now does your jaw movement feel nice and smooth when you open and close it? How about when you’re chewing your food? Does your chewing feel nice and smooth like before or X? Or has something changed about the way your jaw feels when it opens or closes, or when you chew?

Question 10

9. Can Px resist attempts to open closed jaw?

Answer 10

This one’s a little trickier - I’ll show you what I want you to do, so just watch me. I want you to put your hand under your jaw with the palm facing down. Now I want you to try to open your jaw, but at the same time I want you to press up with your hand, to try to stop your jaw opening. I want to see if you are able to open your jaw, even though you are trying to stop it opening with your hand. It’s also important to try to keep your head and neck still, and only open your jaw in a downwards direction. Have a go for me. How did that feel? Was it fairly easy to open your jaw?

Question 11

10. Can Px move jaw laterally?

Answer 11

Now have a watch of my face and see if you can move your jaw from side to side, like this? How did it feel? Was it easier on one side, or were they both about the same?

Question 12

11. Does Px complain of facial pain?

Answer 12

Has your face or jaw hurt when I’ve asked you to do any of those things today? Do you find that you get pain in your face at all, since your X?

Question 13

12. Can Px feel cotton swab on all 3 branches?

Answer 13

Now I’m going to see if the feeling in your face is working in different parts of your face. I’m just going to get you to grab a tissue. Fold it in half. Now fold it half again (demonstrate). Now roll it up in a cylinder like this (demonstrate). I’m going to get you to touch the end of the cylinder to your face here, just above your eyebrow (touch mine with finger). Did you feel that? Then just above your other eyebrow (touch mine with finger). Did you feel that? Did it feel the same on both sides?
Now I’ll get you to touch it to your face here on your cheek, just next to your nose. Did you feel that? Then here on your other cheek just next to your nose. Did you feel that? Did they both feel the same?
Now I’ll get you to touch it to your face here on one side of your jaw, below the corner of your mouth. Did you feel that? And touch it to the other side of your jaw below the corner of your mouth. Did you feel that? Did they feel the same? Good.

Question 14

15. Is face symmetrical at rest?

Answer 14

Now just relax your face for me, and look straight at the camera. Good.

Question 15

16. Can Px wrinkle forhead when looking up?

Answer 15

Can you please bring your face nice and close to the cameral for me. Are you comfortable? Now, without moving your head or neck, can you try to look at the ceiling, just above your head. Don’t tilt your head, just with your eyes. Maybe you’ll have to raise your eyebrows to do that. Great, thank you.
[If no wrinkling - have you ever had botox injections in your forehead? When was that?]

Question 16

17. Does wrinkling occur around the eyes when closed tightly?

Answer 16

Now keep your face close to the camera where it it, and close your eyes as tightly as possible. I’m just checking for wrinkles around your eyes, believe it or not. That’s great, you can open your eyes now.

Question 17

18. Is smile symmetrical?

Answer 17

And looking straight at the camera, give me a bit smile. Can you smile again, and hold that smile for me. Thank you.

Question 18

19. Can Px maintain a lip seal?

Answer 18

This one’s a little trickier. I want you fill your mouth with air and puff your cheeks up as big and round as they can go. Nod if you are managing to hold the air in there. Good, now I want you to poke one cheek with your finger a bit, but see if you can magage to hold the air in your mouth with your cheeks puffed up, still. Now poke a bit with your finger on the other side. You can let go now. Did you manage to hold the air in there? Do you use mouthwash? (if yes: Have you noticed when you use mouthwash and swish it around your mouth, that you are managing to hold the mouthwash in when you spit?) Have you noticed any food or drink escaping from your mouth when you eat or drink?

Question 19

20. Are sounds uncomfortably loud?

Answer 19

Have you noticed any change in the sensitivity of your hearing, since the X? Does everything sound to loud now? Or does everything sound the same as it used to, before the X?

Question 20

21. Can Px identify taste on anterior 2/3 of tongue?

Answer 20

I’m now going to ask you about whether things taste the same as they did before the X. Or has there been a change in your taste? So things taste just as strong as they always did?
–> ASK CE - I’;m coming out of character for a second: Would we normally have had them put some sugar or salt on the table in front of them, and we’d just get them to put it on the front of their tongue? But if they hadn’t got it ready, just ask because otherwise it would take too long?

Question 21

22. Any changes in salivation? Dry mouth?

Answer 21

Have you noticed any changes in how dry or how wet your mouth feels, since after X/recently? Do you find you are taking drinks while you eat, just to keep the food moist, or are you taking a lot of little drinks to wet your mouth, when you didn’t used to do that? Does your mouth every feel too wet? Do you feel like you have to swallow your saliva much more often than you used to?

Question 22

25. Is there palatal movement with short productions of “ah”?
26. Any deviations of the palate/uvula?

Answer 22

Now, this is going to be really quite tricky. I want to have a look inside your mouth with the torch, like I did at the beginning, but I want you to say a long “ahhhhhh” like you would if you were at the doctors. I’m going to try to see the back of your throat, so we need to try and get the light from the torch into your mouth, without the torch getting in the way - so I can see. So turn your torch on. Shall we practice the ‘ahh’ first? Just like this “Ahhhhhh”. OK, you have a go. Perfect. Now try to keep the torch off to the side of your mouth, but point the light down your throat and say “Ahhhh”. Good, another long “Ahhhhhhh”. Excellent.
Have you ever had any food or drink coming out of your nose while you are eating or drinking, since the X? Can you say “Ahhhh” again, and keep going while you block your nose with your fingers, then let go, then block it again, then let go.

Question 23

27. Has gag reflex changed?

Answer 23

Now, do you have a gag reflex? You know when you’re brushing your teeth and you accidentally go too far back with the toothbrush and gag (demonstrate). I wanted to ask you if you find yourself gagging more, or less, since you have had your X? Do you think how sensitive your gag reflex is, has changed?

Question 24

28. Describe phonation during prolonged vowel.

Answer 24

Remember that “Ahhh” you just did? I’m going to get you to do an even longer version. I’ll give you a demonstration “Ahhhhhhhh”. Can you please do a really long “Ahhhhhhhh” like that for me?
Great. Well do it a few times. Just remember to make it really long, I want to get a good listen to your voice.
REPEAT x 3

Question 25

29. Can Px raise/lower pitch during prolongued vowel/singing scale?

Answer 25

Now I’m just going to have a listen to how you change pitch with your voice. I’ll demonstrate what I want you to do, and you can copy me, OK? First we’re going to start in the middle of your range, and glide your voice up high. (DEMONSTRATE glide high). Good. Can you copy me again (DEMONSTRATE). Great.
Now copy me again, we’re going to start in the middle of your range again, and glide your voice to as low as it can go. (DEMONSTRATE). Good. Can you copy me again? (DEMONSTRATE, glide low). And again. Great, thank you so much.

Question 26

Swallow saliva and trial cough

Answer 26

Now we’re just going to see how you do with drinking some water and eating a biscuit. I want to have a good look at your swallowing. Have you got a clear glass with some water in it? A biscuit? Good. Before we start, do you have any concerns about your swallowing? Have you noticed any changes in your swallowing since your X?

Good. Can you just have a swallow for me, without drinking. Just your saliva. Good. Now say “Ahhhhh”.
Now can you do a cough for me? Do you think you can do a better cough, a nice strong cough? OK, lets practice that one more time. So swallow. “Ahhhhh”. Cough. Great. I’m going to ask you to do that every tie after you have any water or food. Are you OK with that?

Question 27

IDDSI 0 fluids (water) - SIPS

Answer 27

Now which hand do you usually use to hold the glass? OK, so I want you to turn your chair so you are side-on to me, but the hand you hold the glass in is away from the camera. Good. If you just touch the front of your neck, can you feel your adams apple? That’s what I’m going to be watching while you swallow, so I want you to keep side-on so I can see for each swallow. Feeling comfortable? Good, I want you to take a small sip.
Now say ‘Ahhh’. OK, can you do a big swallow. Good, now a big cough? Now say “Ahhh again”
REPEAT X 3
–>If coughing wet/gurgly doesn’t clear - stop trial - tell CE would try thicker fluids. Shouldn’t go on with water.

Question 28

IDDSI 0 fluids (water) - SWALLOW comfortable mouthful - as if you were drinking normally, but just a mouthful, not the whole glass.

Answer 28

Good, I want you to take a normal drink of water.
Now say ‘Ahhh’. OK, can you do a big swallow. Good, now a big cough? Now say “Ahhh again”
REPEAT X 3

Question 29

IDDSI 7 solids - tiny bite.

Answer 29

Now we’re going to try a tiny bit of the biscuit. After you try the biscuit, I’m going to check in your mouth, to see if you have any leftover bits between your teeth and cheek, or anywhere in your mouth. Lets have a practice. Can you turn on your torch and turn to face the camera, putting your face nice and close. Good, open your mouth wide, and shine the torch into your mouth like you did before, holding the torch off to the side so it doesn’t block my view. Now I’m just going to get you to pull your cheeck to the side with your finger, and show me the bit of your mouth between your teeth and your cheek. Thank you. Now the other side. Thank you. Well do that every time after you swallow your bite of biscuit. Is that OK with you?

OK, you can take a bite of the biscuit, chew it up, and swallow it. Done? OK, turn to the front and shine the torch in your mouth. Pull one side of your cheeck. The other
–> If residue, as Px to clear it with finger (put in tissue) - tell CE - stop and arrange face-to-face.