Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dysphagia Exam 2 > Class #9 Instrumental Assessment of Adults > Flashcards

Class #9 Instrumental Assessment of Adults Flashcards

1
Q

Indications for an Instrumental Examination

Examination Definitely Indicated:
a)
b)
c)

Examination May Be Indicated:
a)
b)
c)

Examination NOT indicated:
a)
b)
c)

A

a) Characteristics vague
b) Nutritional or respiratory issues
c) Safety of efficiency a concern

a) Medial condition high risk for dysphagia
b) Swallow changes
c) Unable to cooperate with clinical exam

a) No complaints
b) Too medically fragile or uncooperative
c) MBS will not change course of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Decision Pathways

A
  1. History: Feeding observation, Clinical Examination
  2. Determine characteristics
  3. Determine Clinical selection factors
  4. Determine safeness factors, comfort, invasiveness, risks, side effects
  5. Client selection and matching symptoms/ deficits/ age
  6. Refer to gastroenterologist or other medical specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Overview: Instrumental Procedures

A

Videofluorscopy: radiology tech actually runs it, but we are present

Ultrasonography: sometimes done with children because it’s safer

Fiberoptic Endoscopy (FEES): done by otolaryngologist or trained SLP

Manometry: tests swallowing pressures. Done with GERD. Tube goes through the nose and into the esophagus all the way down to the stomach

Scintigraphy: swallow radioactive bolus and watch how it drains in the stomach.

Cervical Auscultation: can and will do this. Listening with a stethoscope for the clicks in the swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical Selection Factors

Visualizes Complete Swallow

a) Best:
b) Partial:
c) Unable to visualize:

Detects Aspiration

a) Best
b) partial
c) Minimal

Uses Natural Diet

a) Best
b) partial
c) Minimal

Can be Used during treatment

a) Best
b) Moderate
c) Minimal

A

Visualizes Complete Swallow:

a) Best: Videofluoroscopy
b) Partial: Ultrasound, FEES, scintigraphy, manometry
c) Unable to visualize: cervical auscultation

Detects Aspiration

a) Best: scintigraphy, Videofluoroscopy
b) partial: Manometry, FEES, cervical auscultation
c) Minimal: Ultrasound?

Uses Natural Diet

a) Best: Ultrasound, cervical auscultation
b) partial: FEES
c) Minimal: Videofluoroscopy, scintigraphy

Can be Used during treatment

a) Best: Ultrasound
b) Moderate: FEES, cervical auscultation
c) Minimal: Videofluoroscopy, scintigraphy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Comparison of MBS vs. FEES

Advantages of Fluoroscopy:

A

Initial evaluation

Esophageal dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Advantages of Endoscopy

A

Paralysis

Anatomic deviations

Secretions

Ease of transport

Repeated use

Biofeedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Safety Factors of Procedures

Risks (Most to least):

Side Effects (Most to least):

Invasiveness (Most to least):

Comfort (Most to least):

A

Risks: Videofluoroscopy, manofluorography, Scintigraphy, FEES, Manometry, CA, Ultrasound

Side Effects: FEES, manometry, manofluorography, Scintigraphy, videofluoroscopy, CA, Ultrasound

Invasiveness: Manometry, FEES,videofluoroscopy, Scintigraphy, CA, Ultrasound

Comfort:
Ultrasound, CA, Videofluoroscopy, Scintigraphy, FEES, Manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Two studies Comparing Agreement between VFSS and FEES

Pharyngeal Residue
VFSS:
FEES:

Aspiration
VFSS:
FEES:

Laryngeal penetration
VFSS:
FEES:

Premature spillage
VFSS:
FEES:

A

80%; 89%

90%; 86%

85%; 86%

66%; 61%

Fairly similar.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Videofluoroscopic Examinations

What’s in a Name?
Terminology:

Procedures:

A

Modified Barium Swallow (MBS)

Upper Gastrointestinal Series with hypopharynx

Videofluoroscopic Swallow study (VFSS)

Videofluoroscopic barium examination (VFBE)

Videofluoroscopic swallow examination (VFSE)

Rehabilitation swallow study
Video-esophagram (early Logemann!)

Dysphagiagram (Okie term!)

(See hand-outs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Principles of VFSS

X-ray tube moves ____

X-ray projected in straight
lines through the patient to
_______

Differences in _______ produces varying _____(darkness)

Radiation dose rate falls when _______are examined and rises with the examination of ____

A

up and down

the fluoroscope on the opposite side

tissue absorption; intensity

thin body parts; thick parts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sequence of materials-

Lateral View:

_____ and _______

1.
2.
3.
4.
5.
6.
7.
8.

Repeat thin liquid if…

A

speech sample and vowel phonation

Speech sample and vowel phonation

5 ml thick liquid barium
5 ml barium paste (with pudding)
10 ml thin liquid barium
10 ml thick liquid barium
10 ml barium paste (pudding)
Thick liquid taken from a cup or through a straw
Cracker coated with barium paste

residue from cracker is still there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Materials & Sequence

Anterior View: Repeat ____ and _____

Swallow with _______

Compensatory techniques:

May try at any time in the examination
Esophageal evaluation
Quick view for obstruction or dysmotility
Some Radiologists require this view

A

vowel phonation and falsetto

head forward and turned

Compensatory techniques:
1. May try at any time in the examination

  1. Esophageal evaluation
    a) Quick view for obstruction or dysmotility
    b) Some Radiologists require this view
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Observations to Obtain

1. \_\_\_\_\_\_
2\_\_\_\_\_\_\_\_\_ movement
3. \_\_\_\_\_\_\_\_movement
4. Consequences of \_\_\_\_\_\_\_
5. Impact of \_\_\_\_\_\_\_\_
A
  1. Anatomy
  2. Non-Swallow
  3. Swallow
  4. impaired swallow
  5. compensatory maneuvers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anatomy review

A

Slide 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Basic Procedures

I. Lateral view:
Study _____

Food consistencies:

A

structures

Liquid- graded thicknesses
Barium Paste-pudding
Cookie – solid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

II. A-P view:

  1. _______
    2.
A
  1. Structures

2. Liquid Barium – graded thicknesses

17
Q

Warning!!!Safety Issues

Radiation risks:
1.
2.
3.
4.
a)
b)
A
  1. Severe tissue damage
  2. Cancer
  3. Genetic Injury
  4. Fetal Exposure-
    a) 1 1/2 – 2x more sensitive
    b) Greatest during first 10 days in utero
18
Q

Areas of greatest risk to exposure:

A

Thyroid, lungs, breasts, active bone marrow, ovaries & testes

19
Q

Safety Issues

Radiation Protection:
Time-

Shielding
1.
2.
3.
4.

Distance:
a)
b)

Equipment & Dosimetry
a)
b)

A

Time:
minimize exposure time- less than 2 minutes

Shielding:

  1. Lead lined apron
  2. Lead lined gloves
  3. Lead lined thyroid shield
  4. Lead lined glasses

Distance:

a) Scatter- principle hazard to operator
b) Inverse square law: if distance is doubled, exposure cut in half

Equipment & Dosimetry

a) Wear a dosimeter badge
b) Keep levels below 0.01-10 cGy (centiGrays)

20
Q

Radiation Basics

Radiation absorbed dose (___) measured in ____

1 Gray (Gy)= _____

Most work in _____

1cGy= ______

Level normally encountered in Dx radiology = ______

Radiation Workers

A

(rads); Grays

100 rads

centiGrays

1/100 Gy and 1 rad

  1. 01-10 cGy
  2. 5 cGy per month
21
Q

Reliability of VFSS

Interrater reliability was ___

____ the only finding with high interrater agreement

Suggests the need for programs like the ____

A

poor

Aspiration

MBS-Imp

22
Q

Endoscopic ExaminationsObservations

1.
2.
3.
4.

A

Velopharynx

Pharynx

Larynx

Swallow

23
Q

Procedures

  1. Pass…
  2. Observe…
  3. Swallowing…
  4. Assess:
  5. Success of…
A

the scope into the nose and down the throat

throat before and after the swallow ***During the swallow the camera will be white

of small amounts of dyed food

a) Soft palate
b) Back of tongue movement
c) Larynx

compensatory techniques

Dysphagia Exam 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions