Class 9 Flashcards
When would you definitely need to perform an instrumental exam?
If the person had a history of pneumonia and recent coughing/choking incidents that were severe in nature.
On the first day of your externship at St. Francis Hospital in Tulsa, your supervisor tells you to recommend a client for a “dysphagiagram.” You check your textbook but there is no mention of such a test. What is he/she talking about?
A Modified Barium Swallow (MBS)
A Videofluoroscopy/Modified Barium Swallow test is essentially a movie of an X-ray event.
True
Why do you need to mix foods with barium during an MBS?
Barium is radiopaque and appears black on an image making it easier to see and track.
If time and circumstances allow, it is a good idea to practice your compensatory maneuvers during a videofluoroscopy evaluation to determine effectiveness for your particular client.
True
According to your textbook and the Kelchner article, the radiation exposure of an MBS is minimal and extended or repeated exposure poses no risk to either patient or examiner.
False
Which of the following would be considered a disadvantage of choosing to perform a Fiberoptic Endoscopy (FEES) exam over the MBS for a client with suspected dysphagia?
You can view esophageal dysphagia as well as oral and pharyngeal stages.
Martin-Harris stated in her 2008 article that the MBSImp program was initially designed to___________.
Improve the interrater reliability of MBS results among speech-language pathologists.
In the article on radiation safety, Kelchner recommended which of the following safety measures for the SLP performing multiple evaluations per week? (Choose all that apply.)
Wearing a lead apron during all MBS/VFSS procedures.
Increasing the distance from the source of the radiation.
Minimizing the exposure time for you and your patient.
Indications for an Instrumental Examination (Text: Box 10-2)
◦ Examination Definitely Indicated:
Characteristics vague
Nutritional or respiratory issues
Safety of efficiency a concern
◦ Examination May Be Indicated
Medial condition high risk for dysphagia
Swallow changes
Unable to cooperate with clinical exam
◦ Examination NOT indicated
No complaints
Too medically fragile or uncooperative
MBS will not change course of treatment
Overview: Instrumental Procedures
Cherney, 1994
◦ Videofluorscopy ◦ Ultrasonography ◦ Fiberoptic Endoscopy (FEES) ◦ Manometry ◦ Scintigraphy ◦ Cervical Auscultation
Clinical Selection Factors
◦ Visualizes Complete Swallow ◦ Detects Aspiration ◦ Uses Natural Diet ◦ Can be Used during treatment *Handout Table 5-3
Comparison of MBS vs. FEES
◦ Advantages of Fluoroscopy
Initial evaluation
Esophageal dysphagia
◦ Advantages of Endoscopy Paralysis Anatomic deviations Secretions Ease of transport Repeated use Biofeedback
Safety Factors of Procedures
Cherney, 1994
◦ Risks: Most risk to patient to least risk to patient
◦ Side Effects: Most to least
◦ Invasiveness: Most to least
◦ Comfort: Most to least
Two studies Comparing Agreement between VFSS and FEES
Langmore, Shatz, & Olson, 1991 and Wu, Hsiao, & Chen, 1997
◦ Pharyngeal Residue VFSS: 80%FEES: 89%
◦ Aspiration VFSS: 90% FEES: 86%
◦ Laryngeal penetration VFSS: 85% FEES: 86%
◦ Premature spillage VFSS: 66% FEES: 61%
