Assessment

Question 0

2 main swallowing assessments

Answer 0

1) videofluroscopic swallow study (VFSS)

2) flexible endoscopic evaluation of swallowing (FEES)

Question 1

Best way to assess esophagus

Answer 1

Laying down

Question 2

VFSS

Answer 2

To see anatomy and physiology
Identify abnormalities
Assess need and benefits of tx

Question 3

Views seen with a VFSS

Answer 3

Lateral
Frontal
Oblique - assesses esophagus
Horizontal

Question 4

Why use VFSS

Answer 4

Dysphagia is not limited to oral phase

If pharyngeal dysphagia is suspected

Aspiration suspected

Question 5

Components of a bedside swallow evaluation

Answer 5

1) chart history
2) history intake
3) oral motor exam
4) presentation of foods
5) trail therapy
6) tx plan

Question 6

Things to ask during a bedside swallow

Answer 6

Symptoms
Occurrence/onset 
Frequency of occurrence 
Pneumonia 
Weight loss?
Social implications

Question 7

Nutritional status?

Answer 7

Oral vs nonoral intake of combo

Question 8

Structures to observe in an oral motor exam

Answer 8

Lips
Face
Jaw
Teeth
Tongue
Soft palate
Hard palate
Facillicial pilars
Face
Cheeks
Sulcii
Secretions 
Reflex, cough, gag

Question 9

Things to test during an oral motor exam

Answer 9

Appearance 
Symmetry
Sensation
Strength
Range of motion
Accuracy
Speed
Hygiene

Question 10

Things to look at immediately entering a room

Answer 10

Posture
Level of alertness
Breathing status
Communication status

Question 11

What to look for in an oral motor exam

Answer 11

Lip closure
Drooling
Oral residue
Larynx elevating

Question 12

What to listen for during an oral mech exam

Answer 12

Wet/gurgle voice
Cough
Quiet breathing
Cervical ausalitation (using stethoscope to listen to swallow)

Question 13

What to feel for during oral mech exam

Answer 13

BOT retraction
Swallow initation
Laryngeal elevation 
VF vibration 
Oral pharyngeal transit time

Question 14

Things you can’t see with a bedside swallow eval

Answer 14

Premature spillage 
Bolus formation/transit
Pharyngeal residue
Precise OTT and PTT times 
Penetration
Silent aspiration

Question 15

Modified Evans blue dye test

Answer 15

MEBT
Besides screening for aspiration
Examine tracheal secretions for evidence of blue tint
50% false negative error rate

Question 16

How many percentage of patients that aspirate aren’t identified at bedside eval

Answer 16

38-40%

Question 17

Glucose oxidase testing

Answer 17

Tracheal secretions have little/no glucose content

Increased glucose = sign of partition

Uses expensive strips to test

Question 18

Pulse oximetry

Answer 18

Oxygenation saturation
Pulse waveform
Amount of light detected

Question 19

Strength of VFSS

Answer 19

Dynamic
Thorough
Unlimited review

Question 20

Weaknesses of VFSS

Answer 20

Radiation exposure
Abnormal environment
“Snapshot” of function

Question 21

Aspects of a clinical evaluation for children

Answer 21

Medical and developmental history 
Typical feeding and swallowing patterns 
Growth patterns and physical 
Feeding readiness 
Observation of feeding

Question 22

Things to look at with a child evaluation

Answer 22

Respiration
Tone
Posture
Alertness
Response to sensory stimuli 
Suckling rates (non nutritive sucking) 2 sucks per second