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
