Assessment

Question 1

when is an oral trial appropriate?

Answer 1

o Once finish with OME (SOOB) proceed to oral trials or a meal time observation:
 Conscious & alert
 Able to be positioned optimally for oral intake
 Show some ability to protect the airway
 Have sufficient stamina for the trial
o During Oral Trial, also trial suitable treatment strategies

Question 2

why and who would you use VFSS with?

Answer 2

o Parkinson’s Disease – as silent aspiration is a serious risk factor
o Suitable for client’s with suspected penetration which may lead to aspiration
o Not suitable for others either due to cognitive impairments, agitated, confused, disorientation

Question 3

VFSS GAINS

Answer 3

o You can see bolus/oral prep
o Symmetry/pooling in oral cavity
o The VPS
o Premature spillage
o HLE and ED are well distinguished
o You can see Pharyngeal constriction and residue (pharyngeal, valleculae/pyriform sinus – compare left and right)
o You can see penetration and aspiration
o View the larynx, vocal folds and trachea
o See if multiple swallows were needed
o Tongue function (bolus control and propulsion)

Question 4

Pulse Oximetry

Answer 4

o Huntington’s Disease, Brainstem Stroke, MND
o If suspected AP or aspiration of a lot of fluid, they may exhibit low levels of O2  good to test
o Limited diagnostic potential…however is a useful adjunct to bedside assessment
o A fall of 2-4% from baseline, during or following an oral trial may be indicative of aspiration

Question 5

FEES

Answer 5

o Bedside swallowing assessment – suitable for patients with limited mobility affecting client’s ability to complete assessments requiring to be SOOB such as OME, Oral Trials.

Question 6

FEES GAINS

Answer 6

o	Spillage into pharynx 
o	Initiation of the swallow 
o	Oral/pharyngeal clearance 
o	Aspiration before the swallow 
o	Aspiration during the swallow (during white out – evident from residue after the air space returns)
o	Sensory awareness and response

Question 7

Oral Trials general

Answer 7

• Start with the consistency and amount that your client is most likely to manage
o Test / palpate dry swallow first
o Double check oral hygiene! (mouth care pre-trials)
o For liquids, recommended that your start with water trials (pH neutral) (teaspoons up)
• Try other consistencies – depending on outcome (^/ v)
• Ideally, try letting the patient self-feed if possible

Question 8

Palpate the swallow during trials

Answer 8

o Judge promptness of swallow reflex initiation
o Judge range, strength and coordination of hyolaryngeal excursion
o Check voice quality after the swallow
o Observe swallowing physiology/judge each stage of swallowing
o Check for oral residue post swallow trials
o Note any alterations to client state during trials (e.g. change in rate or depth of respiration, regurgitation, distress)
o Judge stamina and fatigue levels
o Seek feedback from client about how they are going
o Observe any compensations that client is using (e.g. tiny bites, extending head back, chin tuck)
o Consider need for oral toilet or suction during or after the oral trial (severe dysphagia)

Question 9

Oral Trials Checklist

Answer 9

• Ability to open mouth/accept the bolus
• Ability to close the mouth to contain the bolus
• Evidence of primitive reflexes (e.g. bite reflex)
• Ability to control the bolus orally using the lips, cheeks, and tongue to form a cohesive bolus that is suitable to swallow
• Evidence of prompt, delayed or effortful swallow initiation
• Presence or absence of hyolaryngeal excursion
• Note whether the oral and pharyngeal stages appear coordinated
• Note whether respiration and swallowing appear coordinated
• Evidence of phonatory changes following swallowing (i.e. moist, gurgly, wet voice)
• Note any instances of reflexive coughing or throat clearing following the swallow
• Observe the overall timing of the swallow – is it fast or slow and effortful
• Note the need for multiple swallows
• Are there any reports of pain or discomfort?
• Check for oral residue after the swallow – is this cleared spontaneously or not?