Assessment Flashcards
2 main swallowing assessments
1) videofluroscopic swallow study (VFSS)
2) flexible endoscopic evaluation of swallowing (FEES)
Best way to assess esophagus
Laying down
VFSS
To see anatomy and physiology
Identify abnormalities
Assess need and benefits of tx
Views seen with a VFSS
Lateral
Frontal
Oblique - assesses esophagus
Horizontal
Why use VFSS
Dysphagia is not limited to oral phase
If pharyngeal dysphagia is suspected
Aspiration suspected
Components of a bedside swallow evaluation
1) chart history
2) history intake
3) oral motor exam
4) presentation of foods
5) trail therapy
6) tx plan
Things to ask during a bedside swallow
Symptoms Occurrence/onset Frequency of occurrence Pneumonia Weight loss? Social implications
Nutritional status?
Oral vs nonoral intake of combo
Structures to observe in an oral motor exam
Lips Face Jaw Teeth Tongue Soft palate Hard palate Facillicial pilars Face Cheeks Sulcii Secretions Reflex, cough, gag
Things to test during an oral motor exam
Appearance Symmetry Sensation Strength Range of motion Accuracy Speed Hygiene
Things to look at immediately entering a room
Posture
Level of alertness
Breathing status
Communication status
What to look for in an oral motor exam
Lip closure
Drooling
Oral residue
Larynx elevating
What to listen for during an oral mech exam
Wet/gurgle voice
Cough
Quiet breathing
Cervical ausalitation (using stethoscope to listen to swallow)
What to feel for during oral mech exam
BOT retraction Swallow initation Laryngeal elevation VF vibration Oral pharyngeal transit time
Things you can’t see with a bedside swallow eval
Premature spillage Bolus formation/transit Pharyngeal residue Precise OTT and PTT times Penetration Silent aspiration
Modified Evans blue dye test
MEBT
Besides screening for aspiration
Examine tracheal secretions for evidence of blue tint
50% false negative error rate
How many percentage of patients that aspirate aren’t identified at bedside eval
38-40%
Glucose oxidase testing
Tracheal secretions have little/no glucose content
Increased glucose = sign of partition
Uses expensive strips to test
Pulse oximetry
Oxygenation saturation
Pulse waveform
Amount of light detected
Strength of VFSS
Dynamic
Thorough
Unlimited review
Weaknesses of VFSS
Radiation exposure
Abnormal environment
“Snapshot” of function
Aspects of a clinical evaluation for children
Medical and developmental history Typical feeding and swallowing patterns Growth patterns and physical Feeding readiness Observation of feeding
Things to look at with a child evaluation
Respiration Tone Posture Alertness Response to sensory stimuli Suckling rates (non nutritive sucking) 2 sucks per second
