Clinical Bedside Swallowing Assessment Flashcards
What are we looking for in a subjective assessment of swallowing?
Visible signs of aspiration
Limitations of clinical swallowing exam.
1) Can only detect risk of aspiration.
2) Limited diagnostic ability: may provide sufficient info to diagnose ORAL DYSPHAGIA - many physiological measures cannot be determined because you cannot see the structures.
Is a bedside assessment of swallowing subjective or objective?
Subjective
What are two objective measures of swallowing?
1) VFSS
2) FEES
What are the goals of a clinical bedside swallow evaluation?
1) Make a perceptual judgement about patient’s safety and efficiency for eating/drinking by mouth without instrumental assessment.
2) Determine if patient has dysphagia.
What is a sign?
Something tangible that you observe.
Ex) you hear patient cough after eating/drinking
What is a symptom?
Something the patient reports.
Ex) patient says “food gets stuck in my throat when eating”.
What is the only physiological measure that can be determined with a clinical swallowing exam?
Hyolaryngeal excursion
What is the primary purpose of a case history? Second/third purposes?
1) Identify which stages of the swallow might be impaired/specific locations.
2) Identify safest material for patient to swallow so clinician knows where to start in oral trials.
3) Get some indication that there is a swallowing disorder/what might be the cause.
In terms of differential diagnosis, a carefully conducted case history should answer 2 general questions:
1) Is the dysphagia oropharyngeal or oesophageal in nature?
2) Is it caused by mechanical/structural obstruction or a neurological motility disorder?
Case History & Current Status (5)
1) Respiratory Hx/Status
- Chest infections
- Abnormal breath sounds (wheezing, crackling); Asthma
- Altered respiratory rate (slowed/fast breathing or laboured breathing)
- Intubated (feeding tube, tracheotomy tube, ventilator)
2) Nutritional Hx/Status
- Diet type
- Duration of mealtime
- Adequate nutrition & hydration
- Nutritional intake (oral or non-oral)
- Diabetes?
3) Medical Hx/Status
- Medical diagnosis
- GI (GERD, heart burn)
- Congenital and/or neurological disorders
- Recent illnesses
- Surgeries and/or hospitalisations
- Medications used (particularly ones that reduce alertness and reaction time) and/or recent med changes
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4) Dysphagia Hx/Status
- Precious SP assessment/management
- Onset (sudden vs. gradual; progressive vs. improving; fluctuating vs. stable)
- Symptoms
- Factors that alleviate/exacerbate swallowing difficulties
- Consistencies that are easier and more difficult to swallow
5) Sociocultural Status
- Cultural, religious, and/or personal reasons for food preferences
General Observations (7)
1) Level of alertness
- Drowsy/awake, oriented to person & place
- Cognition/ability to follow instructions
- Ability to participate/respond
2) Communication status
- Presence of language impairment or MSD
- Language barrier
- Adequate hearing/vision
3) Posture/Positioning
- Habitual head positioning
- Sitting upright at 45 degree angle
4) Ability to independently self-feed, based on movement of arms
5) Ability to manage recreations
- Presence of drooling or coughing on saliva
6) Respiratory status
- Abnormal breath sounds (wheezing, crackling)
- Breathing pattern: mouth vs nose
- Respiratory rate
7) Client’s state (distressed, agitated)
Reasons why a patient is referred for Dysphagia assessment (7)
(Goals of the Clinical Bedside Swallowing Assessment)
1) Determine presence, nature and severity of swallowing difficulty
2) Aid in medical diagnosis
3) Determine the impact on patient’s activity and participation, and psychosocial well-being (QOL)
4) Obtain baseline measure to track change over time (deteriorating vs improving)
5) Identify swallowing safety, efficiency of oral intake and risk of aspiration.
6) Identify and evaluate effective strategies to maximise swallowing safety, including appropriate diet and liquid textures.
7) Determine if further investigation is needed (instrumental assessment) and/or onward referral
[OME] Things to note during inspection of oral cavity structures. (6)
1) Abnormalities of structures at rest
2) Blisters, lesions or growths
3) Moisture within oral cavity; dryness or thick mucus
4) Oral hygiene
5) Dentition
6) Evidence of food debris - if so, remove it
[OME] Things to note during inspection of oral cavity structures. (6)
1) Abnormalities of structures at rest
2) Blisters, lesions or growths
3) Moisture within oral cavity; dryness or thick mucus
4) Oral hygiene
5) Dentition
6) Evidence of food debris - if so, remove it
