Clinical Bedside Swallowing Exam Flashcards
What is a subjective assessment?
- each clinician has their own opinion
Ex. Clinical Swallowing Exam
What is an objective assessment?
- instrumental
- results will be the same across clinicians
Ex. FEES, MBSS
Is the clinical bedside swallowing exam a screening?
No
What are the disadvantages of a Clinical Swallowing Exam? (2)
- silent aspiration cannot be detected
- several physiological measures cannot be determined because you cannot see the structures
What is the only physiological measure that you can measure with a clinical swallowing exam?
hyo-laryngeal excursion
What is a clinical swallowing exam?
- non-instrumental
- helps to determine if objective assessments need to be performed
- the first exam when the patient comes in
What are the three main parts of a clinical swallowing exam?
History
Cranial Nerve/ Physical Exam
Trial Swallows
What is the purpose of the CSE?
- determine candidacy
- detect possible laryngeal penetration/ aspiration
- determines which textures are safe
- used to monitor progress of therapy and to determine if recommendation needs to be upgraded
What three major concerns are looked for in a CSE?
mental status, nutritional status, and respiratory status
What do you look for in the observation portion?
- alertness
- posture of the patient
- presence of feeding tube
- drooling
- presence of suctioning equipment
- presence of trach or labored breathing
What does the presence of a feeding tube indicate?
partial alternative nutritional support
If the patient has a trach or labored breathing what is a concern?
respiratory status
The presence of suctioning equipment and/or drooling trigger concerns regarding_____ _____.
secretion management
What do we look for during the history portion of the CSE?
- symptoms
- past/ current medical history
- previous swallowing assessments
- socio-cultural status
Why is the socio-cultural status important?
if they are unfamiliar or do not like the food it does not mean they have dysphagia
familial relationships
What are symptoms typically reported by patients?
- weight loss
- food going down the wrong pipe
- feeling of food getting stuck
- specific symptoms of “choking”
How do you test facial sensation?
Use a cotton wisp and a sharp object/ test temperature perception
What three items are done to check for problems with the trigeminal nerve?
- test facial sensation
- look at corneal reflex
- feel the masseter muscles during a jaw clench
How do you test the corneal reflex?
touch each cornea gently with a cotton wisp and observe any asymmetries in the blink response
How do you test for a jaw jerk reflex?
gently tapping on the jaw with the mouth slightly open
What do you look for when testing the muscles of mastication?
- muscles during jaw clench
- jaw jerk reflex
- symmetry of jaw opening
UMN lesions typically cause ______ and are NOT a ____ nerve lesion.
contra-lateral face weakness of the lower part of your face (lower part of your face)
- Facial
LMN lesions on the facial nerve typically cause
weakness involving the whole ipsilateral face (entire half of the face)
What do we look for when testing the facial nerve?
- asymmetry of the face
- check sensation of taste
What asymmetries do we look for when looking at the facial nerve?
facial shape or in depth of furrows such as the nasolabial fold. Also look for asymmetries in spontaneous facial expressions and blinking. Ask patient to smile, puff out their cheeks, clench their eyes tight, wrinkle their brow, and so on.
How do we check for taste when looking at the facial nerve?
Use salt, sugar, or lemon juice on cotton swabs applied to the anterior portion of the tongue
