Class 8 - Exam 2 Flashcards
Why a Clinical Evaluation?
___/___ Evaluation
VERSUS
(Just the) ____ Evaluation
- Some long-term care facilities do not have an ….
- Use as a_____ for instrumental tests
- Use as an _____ measurement
- McCullough, Wertz, & Rosenbek (2000) only____% reliable on clinical exams. Need to standardize the clinical exam.
Clinical/Bedside Evaluation
VERSUS
(Just the) Instrumental Evaluation
- Some long-term care facilities do not have an MBS or FEES machine available.
- Use as a screening for instrumental tests
- Use as an outcome measurement
- McCullough, Wertz, & Rosenbek (2000) only 50% reliable on clinical exams. Need to standardize the clinical exam.
Langmore & Logemann Article
- Discussion:
- Pros and Cons of a bedside evaluation
- Why does Logemann feel that you should always include a clinical exam?
- Clinical questions to be answered
- Percentage of silent aspiration missed
- Langmore recommends ____, why?
- Discussion:
- Pros and Cons of a bedside evaluation
- Why does Logemann feel that you should always include a clinical exam?
- Clinical questions to be answered
- Percentage of silent aspiration missed
- Langmore recommends FEES, why?
Logemann’s 5 Reasons to Pursue a Clinical Exam
1)
2)
3)
4)
5)
1) To define a potential cause of a swallowing disorder
2) To establish a working hypothesis
3) To establish a tentative treatment plan
4) To develop a potential list of questions that may require further study
5) To establish the readiness of the patient to cooperate with further testing
Clinical Evaluation:3 Main Components of a Clinical Evaluation
- ) Medical History-
- -___ Review
- -____ - ) Physical inspection of swallow mechanism
- -___ ___ Exam
- -___ ___ Exam - ) Observation of swallow with test swallows
- -__ ____ test- The Source, Tohara, et al., DiPippo, Holas, & Reding (1992); Garon, Eagle, & Ormistrin (1995)
- -Prediction of ____ with screening tests
- -Various ___ attempted
- ) Medical History-
- -Chart Review
- -Questionnaire - ) Physical inspection of swallow mechanism
- -Cranial Nerve Exam
- -Oral-Mech. Exam - ) Observation of swallow with test swallows
- -3-oz. water test- The Source, Tohara, et al., DiPippo, Holas, & Reding (1992); Garon, Eagle, & Ormistrin (1995)
- -Prediction of Aspiration with screening tests
- -Various consistencies attempted
Dysphagia Questionnaire
- Ask client to describe their …..
- May not be able to …
- ____ or responses may not fit objective findings
- Groher & Crary (textbook) found this is easier when problems are _____ vs. milder dysphagic symptoms
- Ask client to describe their problems and symptoms
- May not be able to describe problems
- Unreliable or responses may not fit objective findings
- Groher & Crary (textbook) found this is easier when problems are severe vs. milder dysphagic symptoms
Samples of Questionnaire
- __ ___ ___ (1991) (in text Box 9-1)
- ___ ___ ___ Test (DiPippo, 1994)
- __ ___ ___ Test (Wallace, et al., 2000)–Designed specifically for ____ Disease
- Baker, Fraser & Baker (1991) (in text Box 9-1)
- Burke Dysphagia Screening Test (DiPippo, 1994)
- Wallace Dysphagia Screening Test (Wallace, et al., 2000)–Designed specifically for Parkinson’s Disease
General Categories of Interview/Questionnaire Findings
- _____
- ___ vs. ____
- _____Reflux
- ____ Habits
- ____ History
- Obstruction: ___ or ___ sensation
- Moser, et al.= more likely to have ___ ___ disorders when reporting this.
- Liquids vs. Solids: solid food dysphagia= esophageal disorders….liquids more likely to have ____ dysphagia
- Choking on liquids and or solids= more ___ related causes….in no choking reported, more likely to have _____ disorders
- GERD: may not associate GERD with dysphagia
- Eating habits: avoiding certain foods, take longer to eat, avoid eating around others,
- Obstruction
- Liquids vs. Solids
- Gastroesophogeal Reflux
- Eating Habits
- Medical History
- Obstruction: globus or globus sensation
- Moser, et al.= more likely to have esophageal motility disorders when reporting this.
- Liquids vs. Solids: solid food dysphagia= esophageal disorders….liquids more likely to have oropharyngeal dysphagia
- Choking on liquids and or solids= more pharyngeal-related causes….in no choking reported, more likely to have esophageal disorders
- GERD: may not associate GERD with dysphagia
- Eating habits: avoiding certain foods, take longer to eat, avoid eating around others,
Physical Examination
~___ Tubes
~_____ Tubes
~____- Oxygen Saturation, Rate. Oxygen levels below ___% indicates at risk for swallowing impairments: Practice O2 sensor
~___ Status - May be unable to cooperate
~__ ___ Examination: Which ones? ____ assessment or screen
~___ Muscles - lips at rest and at work—upper vs. lower motor neuron damage
~Muscles of ____
~____ Muscles
~____ Cavity
~_____
~_____
~Tongue movements: look for ____, atrophy, deviation
~Oral cavity: lesions, thrush infection, saliva, dentition
~Oropharynx: velum at rest and at work, gag reflex (NOTE: presence or absence not indication that they have normal swallow or are at resk. Absence might suggest other problems if other findings are noted.
Pharynx: No clinical tests of pharyngeal function: listen for vocal fold function,
~Feeding Tubes
~Tracheostomy Tubes
~Respiration- Oxygen Saturation, Rate Oxygen levels below 90% indicates at risk for swallowing impairments: Practice O2 sensor
~Mental Status - May be unable to cooperate.
~Cranial Nerve Examination: Which ones? Sonies assessment or screen
~Facial Muscles - lips at rest and at work—upper vs. lower motor neuron damage
~Muscles of Mastication
~Tongue Muscles
~Oral Cavity
~Oropharynx
~Pharynx
~Tongue movements: look for fasciculations atrophy deviation
~Oral cavity: lesions, thrush infection, saliva, dentition
~Oropharynx: velum at rest and at work, gag reflex (NOTE: presence or absence not indication that they have normal swallow or are at resk. Absence might suggest other problems if other findings are noted.
Pharynx: No clinical tests of pharyngeal function: listen for vocal fold function,
Pharyngeal Function- Clinical Evaluation
~\_\_ \_\_\_ \_\_\_ test ~\_\_ \_\_\_\_/ Laryngeal palpation test ~Cervical \_\_\_\_ -\_\_\_ audible sounds -\_\_\_\_: 1. \_\_\_\_ Cardiology II (3M Corp.) 2. \_\_\_ - \_\_\_\_ Pediatric Size (H-P) 3. \_\_\_ surface vs. \_\_\_\_\_ Surface
~Vocal Fold function test ~Digital Manipulation/ Laryngeal palpation test ~Cervical Auscultation -Three audible sounds -Stethescopes: 1. Littman Cardiology II (3M Corp.) 2. Rappaport-Sprague Pediatric Size (H-P) 3. Bell surface vs. Flat Surface
Testing Aspiration Clinically- Is it Reliable? Is it Safe?
~Mann & Hankey (2001)
- Stroke patients N=71)
- Regression Analysis of 23 Clinical features
- 6 variables predictive of aspiration:
1.
2.
3.
4.
5.
6.
~Leder & Espinoza (2002)
- Stroke patients (N=49)
- Clinical exam = underestimated those who ___ and overestimated those who did __ ___
~Mann & Hankey (2001)
- Stroke patients N=71)
- Regression Analysis of 23 Clinical features
- 6 variables predictive of aspiration:
1. Impaired pharyngeal response
2. Male
3. Disabling stroke
4. Incomplete oral clearance
5. Palatal weakness
6. >70 years old
~Leder & Espinoza (2002)
- Stroke patients (N=49)
- Clinical exam = underestimated those
1. who aspirate and overestimated those
2. who did not aspirate
Swallow Tests
~Tohara, et al. Article Review
- Three measures recommend for an effective alternative to instrumental examination
1.
2.
3.
~Groher & Crary:
- Crushed ___ first
- 5- 10 ml of ___ then 20-ml ____ of water
- ___ versus ___, clinician presentation versus client presentation
- Solids in sequence of ____
~Modified Evans Blue Dye Test- MEBD
-For individuals with ____
-Test bolus’ with ____
-Deep suctioning every __ minutes for __ __
-Poor ____
~MEBD: Thompson-Heney & Braddock, 5 patients, MEBD found no ____ but MBS/FEES found that all 5 aspirated.
~Tohara, et al. Article Review
- Three measures recommend for an effective alternative to instrumental examination
1. 3 oz. purified water
2. 4 grams of pudding
3. Plain X-ray of the pharynx
~Groher & Crary:
- Crushed ice first
- 5- 10 ml of water then 20-ml bolus of water
- Cup versus straw, clinician presentation versus client presentation
- Solids in sequence of difficulty
~Modified Evans Blue Dye Test- MEBD
-For individuals with tracheostomies
-Test bolus’ with blue dye
-Deep suctioning every 15 minutes for one hour
-Poor reliability
~MEBD: Thompson-Heney & Braddock, 5 patients, MEBD found no aspiration but MBS/FEES found that all 5 aspirated.
Feeding Evaluation
~Consistencies: Simplest to most difficult
- ___
- Thickened liquids:
1. ___ ___ (easiest to swallow)
2. ___ thick
3. ____ thick - Chopped/ground/diced
- ___ consistencies
- Regular solids: __ __ to ___
- ___ liquids
~Tools
- ___
- ___
- ___
~Consistencies: Simplest to most difficult
- Purees
- Thickened liquids:
1. Pudding thick (easiest to swallow)
2. Honey thick
3. Nectar thick - Chopped/ground/diced
- Mixed consistencies
- Regular solids: mechanical soft to crumbly
- Thin liquids
~Tools
- Spoon
- Cup
- Straw
Results:The Functional Oral Intake Scale
- _____
- ____ dependent with minimal attempts at food or liquid
- Dependent with consistent intake of __ or ___
- Total __ ___ of a__ ___
- Total __ __ with ___ ___ but requiring ___ ___ or compensations
- Total __ ___ with ___ ___ without __ ___ but with
specific food limitations - Total ….
- NPO
- Tube dependent with minimal attempts at food or liquid
- Dependent with consistent intake of liquid or food
- Total oral diet of a single consistency
- Total oral diet with multiple consistencies but requiring special preparation or compensations
- Total oral diet with multiple consistencies without special preparation but with
specific food limitations - Total oral diet with no restriction
Non-standardized Forms
___ Template
The __ __ __
____ Evaluation
Site Specific Forms/Samples:
SMC
St. Francis
ASHA Template
The Source Clinical Evaluation
Logemann’s Evaluation
Site Specific Forms/Samples:
SMC
St. Francis
Available Clinical Evaluation Instruments- Standardized
~Mann Assessment of Swallowing Function (MASA): First with Psychometric Integrity
- Normed on 128 first-stroke patients
- ___ scale utilized
- ___ areas of assessment
~McGill Ingestive Skills Assessment (MISA)
- ___ test, offers a predictive code
- Clinically assesses in ____ environment
- Examiner prepares various __ ___, patient attempts to eat them.
- Designed for clinicians working with ___ adults in a __ ___ ___.
- ___ areas of performance, 43 test items, 3-point scale for each.
~Mann Assessment of Swallowing Function (MASA): First with Psychometric Integrity
- Normed on 128 first-stroke patients
- Rating scale utilized
- 24 areas of assessment
~McGill Ingestive Skills Assessment (MISA)
- Standardized test, offers a predictive code
- Clinically assesses in natural environment
- Examiner prepares various food items, patient attempts to eat them.
- Designed for clinicians working with older adults in a skilled nursing facility.
- Five areas of performance, 43 test items, 3-point scale for each.
