Clinical Assessment Flashcards
What are the difference between screening and diagnostic tools?
Screening tells us whether they have dysphagia
Diagnostic tells us why they have dysphagia
What are the aims of dysphagia assessment?
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
Screening identifies signs and symptoms of dysphagia - true or false
True
General screening tools are generally designed for use by nurses and non-SLPs - true or false
True
What are the typical components of a screening test
Medical information
Signs and symptoms
Water swallow test
A clinical swallow exam provides info on…
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
What do you need for a CSE.
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
What are the four components of a clinical bedside examination?
Case history and patient observations
Oromotor examination
Food trials - with and without compensatory techniques
Clinical decision making and recommendations
What do we want from patient observations?
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
What do we get from the case historyL
History of swallowing problem
Eating habits
Voice change?
Respiratory symptoms
What do we test in the oromotor examination?
How the cranial nerves are functioning
Whether they can do a dry swallow
What do we test for the facial nerve?
General facial expression
Can they raise eyebrows
smile, pucker, hold air in cheeks
If they have an impaired facial nerve, what does this mean?
They might have impaired taste on the anterior 2/3 of the tongue
What are we looking for with the trigeminal nerve?
Masseter muscle - can they bite together? Feel strength
Open and close jaw against resistance
Examine extent of jaw opening
What does an impaired trigeminal nerve mean?
Possible sensory impairment in oral cavity and anterior 2/3 of tongue
What do we want to assess inside the mouth at rest?
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
What do we test for with the hypoglossal?
Strength against resistance - use tongue depressor to put against
Lingual movement
What palatal movement do we look for?
Velar elevation
Listen for hypernasality
What to look for in the larynx
Vocal quality
Cough
How do the thickened fluids differ?
Cohesion, gravity, speed of flow, effort to propel
How do the foods differ?
Mastication, bite force, cohesion of bolus, dry/moist
What do we do during these trials?
Watch
Feel
Listen
What inferences do we make from swallow exam?
Oral parameters
Pharyngeal parameters
Laryngeal/respiratory parameters
Cricopharyngeal problems
What are the limitations of a clinical exam?
Poor ability to characterise the pharyngeal phase of the swallow
Use as a screening assessment for for monitoring
Need something else for silent aspiration
