Clinical Assessment of Swallowing in Adults: Bedside Swallow Eval

Question 1

What are the components of a bedside exam?

Answer 1

History/Chart review and physical exam

Question 2

What does a physical exam include?

Answer 2

Oral mech exam and test swallows

Question 3

In an initial test swallow, what must 1st be decided?

Answer 3

We must decide whether to proceed with food presentation

Question 4

to feed or not to feed

If pt is PO: __________:: if pt is NPO:_____________

Answer 4

pt is PO: feed unless significant deficits are observed on oral-facial exam/high risk of aspiration

pt is NPO: DON’T FEED

Question 5

Reduced alertness, reduced responsiveness to stimulation, absent swallow, absent protective cough, sig. reduced range and strength of oral motor and laryngeal movements, difficulty handling secretions, medical instability are all signs that indicate ???

Answer 5

patients at risk for aspiration

Question 6

In initial test swallow, what follows whether to proceed w/ food or not?

Answer 6

consideration of food textures/consistencies, position changes and placement of food in mouth

Question 7

What do you do if you decide not to feed (test swallows)?

Answer 7

you will recommend NPO and MBSS (VFSS) for follw up/further examination

Question 8

What are some methods of delivery fir trials of swallows?

Answer 8

spoon, cup, straw.

Question 9

thing liquids: _________:: thick liquids:__________

Answer 9

i. e., water

i. e., nectar

Question 10

types of conistency: start to end

Answer 10

thin liquids –> thickened liquids (nectar, honey thick, pudding) –>puree –> mechanically altered foods –> solids

Question 11

What is one way you can reduce chance of getting pneumonia if pt aspirates?

Answer 11

by performing oral hygiene before giving trials

before trials of swallow, treatment and after oral intake

Question 12

Sequence of swallows

Answer 12

dry swallow –> swallows –> phonate ah after each swallow

Question 13

What 4 things do you look for during trials of swallows?

Answer 13

1. estimate oral transit and pharyngeal delay time
2. phonate after swallow
3. listen for gurgly voice, coughing
4. head rotation, chin elevated, followed by phonation

Question 14

During trial eating/ feeding what things do you observe?

Answer 14

• Reaction to food/self-feeding skills
• Oral movements in chewing
• Coughing, clearing throat or struggle behaviors
• Changes in breathing, secretion levels through meal
• Duration of meal and total intake
• Co-ordination of breathing and swallowing

Question 15

____% to ____% of pts who are silent aspirators are missed.

Answer 15

50 to 60%

Question 16

It is important to remember as you begin the feeding trial if a voluntary cough was noted previously this does NOT ensure that a reflexive cough is present. T or F?

Answer 16

True

Question 17

the cough reflex is innervated by which CN?

Answer 17

CN X

Question 18

using a straw requires?

Answer 18

may require more coordination skills

Question 19

Before and after the swallow, what should the examiner be cognizant of?

Answer 19

the respiratory rate

Question 20

marked change in the respiratory rate or an increase in respiratory congestion may be a sign of what?

Answer 20

aiway compromise

Question 21

poor oral control, food texture is?

Answer 21

thicker

Question 22

delayed trigger, food texture is?

Answer 22

thicker

Question 23

poor base of tongue movement, food texture is?

Answer 23

thinner

Question 24

reduced tongue coordination, food texture is?

Answer 24

thicker

Question 25

reduced laryngreal closure/weak cough/grunt, food texture is?

Answer 25

thicker

Question 26

reduced airway closure, food texture is?

Answer 26

thick liquid/pudding

Question 27

What are some weaknesses of bedside swallow exam?

Answer 27

• If the person does not cough, he or she may be silently aspirating
• Although gross estimates of transit times can be made, no real informtion on the pharyngeal stage of the swallow is collected
• Since the structures cannot be seen, the most appropriate therapy cannot be determined
• If silent aspiration is suspected, further exam (instrumental exam) is recommended.

Question 28

If pt is PO, what recommendations are made?

Answer 28

• What kind of diet? Thickened liquids?
• Aspiration precautions? What kinds?
• Any compensatory swallow postures/maneuvers?
• Therapy needed? (for safer swallow or diet upgrade)

Question 29

If pt is NPO, what recommendations are made?

Answer 29

If pt agrees to NPO status then determine:
− How ofen/when to f/u
− Need for tx?

If non-oral feeding (NPO) is refused then the risks needed to be addressed with the pt and family

• Some hospitals will have a form to fill out
• Diet wavier

Question 30

Instrument exam is a must when?

Answer 30

When the decision from the bedside swallow test is NPO (pt is at high risk of aspiration and previously received no MBSS)
or
Pt was admiued to the facility with NPO, and shows significant gains for possible safe oral intake ajer a course of therapy

Question 31

Swallowing safety evals are for?

Answer 31

for pts who are unable to cooperate with a physical eval and who are suspected of dysphagic complications

Question 32

What to look for in swallowing safety eval

Answer 32

across 3 meals you look for:
enviornment
posture
feeding
eating
assistant

Question 33

What are physical signs of aspiration?

Answer 33

• SOB w/ rapid heart rate
• Acute mental confusion (altered mental status)
• Incontinence
• Infection
• Fever and an increase in sputum with cough

Question 34

There are precise mechanisms that lead to aspiration pneumonia. T or F?

Answer 34

False; they are unkown

Question 35

Does aspiration pneumonia develop in all patients who aspirate?

Answer 35

No; but older adults have higher chance to develop it

Question 36

Which groups are predisposed to asp. pneu?

Answer 36

congestive heart failure
COPD
use of medications
feeding dependence 
poor oral hygiene
smoking
history of asp. pneu.
feeding tube
bedbound

Question 37

At what % SpO should you stop feeding?

Answer 37

if below 90%

Question 38

Cervical auscultaPon

Answer 38

monitors the sounds of the swallow using a stethoscope, microphone and accelorometer