Dysphagia Assessment Flashcards

1
Q

What are the steps in dysphagia assessment?

A

History —- > observation —- > OME —-> Trial swallow

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2
Q

What information is recorded regarding a patient’s history?

A

presenting problem, associated sx, ancillary sx, social, environmental, and family history, medical history

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3
Q

Who is on the dysphagia assessment team?

A

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)

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4
Q

What are the contraindications for a trial swallow?

A

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)

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5
Q

What instructions does an SLP give a patient during a trial swallow?

A

They will swallow different types of foods/liquids; chew solids well before swallowing; spit out food before coughing

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6
Q

What is the standard protocol for a trial swallow?

A

phonation, swallow, phonation

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7
Q

What are the goals of a screening?

A

to identify individuals with signs and symptoms of dysphagia or who are at risk of developing dysphagia

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8
Q

What are the obvious goals of dysphagia assessment?

A

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

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9
Q

What are the less obvious goals of dysphagia assessment?

A

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

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10
Q

What are ancillary symptoms that a pt with dysphagia may show?

A

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

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11
Q

What are associated symptoms that a pt with dysphagia may show?

A

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

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12
Q

When determing the present problem of a pt with signs of dysphagia, the following information is considered

A

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

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13
Q

What medical history would you note when assessing a pt for dysphagia?

A

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

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14
Q

What is the IDDSI (International Dysphagia Diet Standardization Initiative?

A

An initiative that aims to standardize the naming and describing texture-modified foods and liquids for trial swallows and people with dysphagia.

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15
Q

What is the purpose of palpation?

A

To assess the laryngeal mechanism during a swallow

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16
Q

When palpating, the index finger should be

A

behind the mandible towards the front of it

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17
Q

When palpating, the middle finger should be

A

pressed against the hyoid bone

18
Q

When palpating, the ring finger should be

A

placed on top of the thyroid cartilage

19
Q

What are the best predictors for an airway that’s been compromised?

A

fail to swallow thins and/or thicks; cough or have a wet voice after swallow; cannot feed themselves

20
Q

What are clinical predictors of dysphagia/aspiration risk?

A

abnormal volitional cough; abnormal gag reflux; coughing or voice change after swallowing; dysphonia; dysarthria

21
Q

What are the aims of imaging procedures?

A

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

22
Q

When would imaging be necessary?

A

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

23
Q

What are the purposes of a VFSS (videofluoroscopic swallow study)?

A

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

24
Q

What are the purposes of FEES (fiberoptic endoscopic evaluation of swallowing)?

A

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.

25
Q

What are the clinical indications for FEES?

A

VPI; to visualize the surface anatomy and mucosal abnormalities; questions about secretion management; visualize laryngeal movement and vocal fold mobility; you want biofeedback; severe dysphagia

26
Q

What are the logical indications for FEES?

A

fluroscopy not available; transportation to fluoroscopy is too risky; family’s input is desired; concerned about using radiation on the patient; positioning the patient is an issue

27
Q

When is imaging possibly indicated?

A

Patient has a medical condition that places them at a high risk for dysphagia; there’s an obvious change seen in how the person swallows; patient cannot cooperate with a full clinical exam

28
Q

When is imaging not indicated?

A

No longer complains of dysphagia; patient’s condition is too medically involved or compromised; exam would not change clinical management or course of clinical actions

29
Q

What are indicates for using MBS?

A

you don’t know the medical etiiology or the symptoms are vague; UES structture/ hypertonicity; to evaluate the oral stage and/or base of tongue movement; to see the mucosal anatony (E.g., cervical osteophytes); laryngetocomy complains

30
Q

What supplemental assessment would be used if a patient is experiencing GERD?

A

reflux disease questionnaire

31
Q

What supplemental assessment would be used to learn about a patient’s current dietary level?

A

functional oral intake scale

32
Q

What supplemental assessment would be used to learn about a patient’s nutritional status

A

mini nutritional assessment

33
Q

What assessment can be used as a screening tool for oropharyngeal dysphagia in community-dwelling elders as well as to learn about dysphagia’s impact on the person?

A

EAT-10

34
Q

What are the indications that MBS should be used?

A

unknown medical etiology or vague symptoms; see the oral stage/movement of the base of the tongue; visualize UES structure and hypertonicity; laryngectomy complaints, see submucosal anatomy to see if there are any abnormalities such as cervical osteophytes

35
Q

Regarding VFSS, two tools for evaluation are

A

MBS (a standardized swallowing assessment and Logemann; Catriona Steele

36
Q

Weaknesses of FEES include

A

safety issues (nosebleed or allergic reaction in the patient); limited view of oral cavity, UES, and esophagus; patient may be aggressive and/or uncooperative or have movement disorders or bleeding disorders

37
Q

What are features of SWAL-QOL assessment?

A

comprehensive (assesses swallowing specific symptoms and swallowing related symptoms); validated for many etiologies of dysphagia (Stroke, HNC), has 10 subsets (e.g., sleep, fatigue, communication, eating duration, eating desire, burden, mental health, food selection, social functioning, and fear)

38
Q

How does VFSS differ from FEES?

A

More comprehensive; radiation is involved; uninterrupted (i.e., is not impacted much by patient behavior)

39
Q

Other methods that can be used during an assessment are

A

cervical auscultation (i.e., using a stethoscope to listen to sounds made by the larynx during swallowing) and observation of a meal (i.e., watch them eat, their behaviors, what they use to eat, duration; ideally watch them during three meals)

40
Q

During a trial swallow, the order of administering liquids is

A

dry swallow —> thin liquid —-> thick liquid —-> chopped/minced —-> puree or pudding —-> solids

41
Q

What is pharyngeal manometry?

A

an instrumental techniques performed in conjunction with VFSS to determine the etiology of pressure changes; it reacts to pressure in the pharynx during pharyngeal swallow. A catheter is placed transnally so that pressure sensors capture information at the tongue base, UES, and cervical esophagus

42
Q

What is electromyography?

A

an instrumental technique in which timing and relative amplitude of muscle contractions during swallowing; popularly used as a biofeedback tool during therapy; surface EMG (sEMG) most commonly used. Electrodes are placed on the surface of skin under the chin or above the thyroid cartilage