Clinical Assessment

Question 0

What are the difference between screening and diagnostic tools?

Answer 0

Screening tells us whether they have dysphagia

Diagnostic tells us why they have dysphagia

Question 1

What are the aims of dysphagia assessment?

Answer 1

Assess ability to protect airway
Determine likelihood of safe oral intake and, if so, the best conditions under which to eat and best consistencies
Determine possible cause of dysphagia
Plan direct or indirect treatment appropriate for specific swallowing disorder
Advice on compensatory techniques
Recommend alternative nutritional management
Determine need for further diagnostic studies
Establish baseline of clinical data

Question 2

Screening identifies signs and symptoms of dysphagia - true or false

Answer 2

True

Question 3

General screening tools are generally designed for use by nurses and non-SLPs - true or false

Answer 3

True

Question 4

What are the typical components of a screening test

Answer 4

Medical information
Signs and symptoms
Water swallow test

Question 5

A clinical swallow exam provides info on…

Answer 5

Medical history  and history of disorder
The patient 
Current nutrition + respiratory status
Oral/mouth care
Oromotor function
Laryngeal function
Cough strength
Swallow function  and aspiration 'risk'
Infers  nature of underlying impairment
Potential  benefits for compensatory strategies/rehab

Question 6

What do you need for a CSE.

Answer 6

Pen and paper  for notes and reporting
Gloves, tongue depressor, gauze/tissues
Swabs
Torch for viewing oral cavity
(Protective goggles - trach patients)
Cup  and   Spoon for  fluid/food trials
Modified fluids
Foods for food trials

Question 7

What are the four components of a clinical bedside examination?

Answer 7

Case history and patient observations
Oromotor examination
Food trials - with and without compensatory techniques
Clinical decision making and recommendations

Question 8

What do we want from patient observations?

Answer 8

Patient’s posture in bed
Level of alertness
Reaction to clinician’s entrance
?tracheostomy tube
Awareness and handling of their own secretions
Ability to follow directions and answer questions
Respiration: rate, coughing, mouth/nose breathing
Speech language cognition
Behaviour

Question 9

What do we get from the case historyL

Answer 9

History of swallowing problem
Eating habits
Voice change?
Respiratory symptoms

Question 10

What do we test in the oromotor examination?

Answer 10

How the cranial nerves are functioning

Whether they can do a dry swallow

Question 11

What do we test for the facial nerve?

Answer 11

General facial expression
Can they raise eyebrows
smile, pucker, hold air in cheeks

Question 12

If they have an impaired facial nerve, what does this mean?

Answer 12

They might have impaired taste on the anterior 2/3 of the tongue

Question 13

What are we looking for with the trigeminal nerve?

Answer 13

Masseter muscle - can they bite together? Feel strength
Open and close jaw against resistance
Examine extent of jaw opening

Question 14

What does an impaired trigeminal nerve mean?

Answer 14

Possible sensory impairment in oral cavity and anterior 2/3 of tongue

Question 15

What do we want to assess inside the mouth at rest?

Answer 15

Hard and soft palate, uvula, posterior pharyngeal wall, lateral sulcus, faucial arches
Tongue at rest - look for signs of atrophy, movements
Check oral mucosa, oral care, dryness, moisture
Check dentition

Question 16

What do we test for with the hypoglossal?

Answer 16

Strength against resistance - use tongue depressor to put against
Lingual movement

Question 17

What palatal movement do we look for?

Answer 17

Velar elevation

Listen for hypernasality

Question 18

What to look for in the larynx

Answer 18

Vocal quality

Cough

Question 19

How do the thickened fluids differ?

Answer 19

Cohesion, gravity, speed of flow, effort to propel

Question 20

How do the foods differ?

Answer 20

Mastication, bite force, cohesion of bolus, dry/moist

Question 21

What do we do during these trials?

Answer 21

Watch
Feel
Listen

Question 22

What inferences do we make from swallow exam?

Answer 22

Oral parameters
Pharyngeal parameters
Laryngeal/respiratory parameters
Cricopharyngeal problems

Question 23

What are the limitations of a clinical exam?

Answer 23

Poor ability to characterise the pharyngeal phase of the swallow
Use as a screening assessment for for monitoring
Need something else for silent aspiration

Question 24

What are the oral parametersL

Answer 24

Labial ability
Mastication
Duration and extent of lingual and oral manipulation 
Bolus formation
Sensory  awareness of bolus
Duration of oral stage
Issues  propelling the bolus

Question 25

What are the pharyngeal parameters

Answer 25

Strength and immediacy of  swallow
Laryngeal excursion by palpation
Number of swallow attempts per bolus
Struggling behaviours
Inefficient pharyngeal phase
Ability to clear secretions or pooled residue

Question 26

What are the laryngeal/respiratory parameters?

Answer 26

Reflexive cough
Volitional cough
Vocal quality

Respiratory capacity

Question 27

Cricopharyngeal problems

Answer 27

Multiple swallows after bolus has cleared oral cavity
Struggling behaviour
Feeling that food gets stuck

Question 28

What can you trial at bedside?

Answer 28

Compensatory techniques
- postural
- delivery
- sensory
- bolus modifications
- bolus control and clearance
Rehabilitate
- voluntary control/manoeuvres
- check potential for independently doing other rehab exercises