Dysphagia Assessment Flashcards
What are the steps in dysphagia assessment?
History —- > observation —- > OME —-> Trial swallow
What information is recorded regarding a patient’s history?
presenting problem, associated sx, ancillary sx, social, environmental, and family history, medical history
Who is on the dysphagia assessment team?
Radiologist (especially if VFSS is used), respiratory therapist (for tracheostomy tube management), nurse, dietitian, ENT (especially if FEES is used and head/neck assessment), physician, neurologist (for a comprehensive assessment)
What are the contraindications for a trial swallow?
Pt has particular medical conditions (e.g., VF paralysis); severe dysarthria, so you are concerned with the airway closing; severe dysphonia; little to no laryngeal movement during a dry swallow; severe cognitive issues (e.g., unable to follow directions)
What instructions does an SLP give a patient during a trial swallow?
They will swallow different types of foods/liquids; chew solids well before swallowing; spit out food before coughing
What is the standard protocol for a trial swallow?
phonation, swallow, phonation
What are the goals of a screening?
to identify individuals with signs and symptoms of dysphagia or who are at risk of developing dysphagia
What are the obvious goals of dysphagia assessment?
to define the presenting problem, to figure the possible etiologies and start referring to the appropriate professional, observe the oral/pharyngeal/laryngeal sensorimotor and swallow function, determine if additional tests are needed, gather pertinent medical and health hx, guess the likelihood of aspiration
What are the less obvious goals of dysphagia assessment?
to determine if alternative nutritional support is needed while the patient waits for additional testing; consider patient’s posture; choose optimum swallowing strategies; assess risk of malnutrition, dehydration, and aspiration pneumonia
What are ancillary symptoms that a pt with dysphagia may show?
weight loss/gain; changes in sleep, energy, speech/voice, eating habits, and feelings about food; dry mouth; fear of eating; compensations made by the patient; avoids eating in public
What are associated symptoms that a pt with dysphagia may show?
coughing/choking while swallowing; mouth odor or food left in the mouth; GER, feeling something stuck in the back of the throat or mouth; chest pain; nasal regurgitation; general pain; feel a lump in the throat
When determing the present problem of a pt with signs of dysphagia, the following information is considered
their typical daily menu; the impact of the consistency, volume, and temperature of the bolus; duration; severity; family’s perception of the problem; circumstances that worsen or lessen the problem
What medical history would you note when assessing a pt for dysphagia?
current medical status; previous medical conditions; family history; previous smoker; airway status; previous problems with swallowing, breathing, their brain, or GI; dental status; previous surgeries; any history of fever
What is the IDDSI (International Dysphagia Diet Standardization Initiative?
An initiative that aims to standardize the naming and describing texture-modified foods and liquids for trial swallows and people with dysphagia.
What is the purpose of palpation?
To assess the laryngeal mechanism during a swallow
When palpating, the index finger should be
behind the mandible towards the front of it
When palpating, the middle finger should be
pressed against the hyoid bone
When palpating, the ring finger should be
placed on top of the thyroid cartilage
What are the best predictors for an airway that’s been compromised?
fail to swallow thins and/or thicks; cough or have a wet voice after swallow; cannot feed themselves
What are clinical predictors of dysphagia/aspiration risk?
abnormal volitional cough; abnormal gag reflux; coughing or voice change after swallowing; dysphonia; dysarthria
What are the aims of imaging procedures?
evaluate the person’s anatomy and physiology; see if they have enough airway protection; evaluate respiraotion/swallowing coordination; assess impact of compensatory maneuvers; evaluate swallowing while swallowing different materials; assess secretions
When would imaging be necessary?
features of dysphagia are unclear; issues with respiration and nutrition make you suspect dysphagia; clinical exam does not answer all your clinical questions; direction for swallow rehab is needed; to determine precipitating medical issues contributing to dysphagia
What are the purposes of a VFSS (videofluoroscopic swallow study)?
To confirm the patient’s symptoms; to assess the consequences of the impaired swallow on safety and efficiency; to examine the patient’s anatomy and physiology; to make recommendations on what the patient should eat or drink as well as their oral diet; to identify the effects compensations have on swallowing; to see how the patient swallows
What are the purposes of FEES (fiberoptic endoscopic evaluation of swallowing)?
to confirm patient symptoms; to identify patterns of the issues the patient has with regards to swallowing; to recommend what the patient should eat and drink as well as suggest interventions or modifications; to see the patient’s anatomy and physiology; to identify the effects of compensations on the patient’s safety and efficiency.
