Beside Swallow

Question 1

What should we look for during the beside swallow exam? (Hint: 12)

Answer 1

1. Coughing/choking while eating
2. Frequent throat clearing
3. Multiple swallowing
4. Wet vocal quality
5. Drooling
6. Shortness of breath (SOB)
7. Resistance to eating/drinking
8. Oral residue (pocketing)
9. Odynophagia (pain when swallowing)
10. Check case history for additional concerns (increased time to eat meal or pulmonary infiltrate on chest x-ray)
11. Edentulous
12. Weight loss

Question 2

T/F: Alertness can modify a person’s swallow

Answer 2

True.

Question 3

When doing a swallowing exam, what do you commonly begin with?

Answer 3

Start with a teaspoon (5cc) of water; unless the client is already drinking

Question 4

What is the liquid hierarchy?

Answer 4

Teaspoon
Small sip
Cup full

Thin liquid (water)
Thicker liquid - nectar
Thickest liquid - honey

Question 5

What is the solid hierarchy?

Answer 5

Purée
Soft solid
Regular solid

Question 6

How do you gain more confidence during a swallow examination?

Answer 6

Give the client more food to eat

Question 7

What is pulse oximetry?

Answer 7

Measures O2 level in blood.

Question 8

What is the purpose of a bedside clinical swallowing eval?

Answer 8

o Screening for possible dysphagia
o Determine, as much as possible, the physiologic factors contributing to dysphagia
o Make determination for need for other tests
o Make recommendations for safest means of intake

Question 9

What are some things to consider when doing a Case Hx?

Answer 9

• ID complaints/consistencies of food
• Onset/progression
• Hx of pneumonia (never know exact cause)
• Reasons of recent hospitalization
• Associated symptoms
• General medical Hx
• Medications (only do this for Pts who seem to have dysphagia but no reason why)
• Social Hx

Question 10

Explain what the difficulty with different consistencies means.

Answer 10

Difficulty w/liquid:
- problem w/control 
- pharyngeal phase is weak/reduced 
- hyolaryngeal elevation is weak/reduced
Difficulty w/solids:
- mastication
- missing teeth
- poor oral control
- weakness

Question 11

Common clinical findings

Answer 11

• increased time to complete meal
• spiking in temperature (take from chart and SLPs don’t deal w/this)
• pulmonary infiltrate on chest X-ray (if in Rt lwr lobe, classic sign of aspiration)
• resistance to eating
• oral residue/pocketing
• odynophagia

Question 12

Describe patterns we often see

Answer 12

BOT propulsion problems = lots of residue in valeculae (aspiration after the swallow)
hyolaryngeal elevation problems = aspiration and UES doesn’t open