Evaluation

Question 1

Aspects of a clinical evaluation/bedside swallow

Answer 1

Chart review
History intake
Oral motor examination
Presentation of foods
Trail therapy (different blouses/different strategies)
Treatment plan with further evaluation if necessary (VFSS, FEES)

Question 2

Assessing respiration (phonation)

Answer 2

Deep breath (Nonspeech) 
#syllables per breath (speech)

Question 3

Functional components of an oral motor exam

Answer 3

Respiration (phonation)
Laryngeal (phonation)
Velum/Pharynx (phonation)
Tongue, lips, face, teeth, jaw (articulation)

Question 4

Assessing laryngeal function

Answer 4

CN X
Nonspeech - cough and clear throat
Speech - loudness and sustained phonation

Question 5

Assessing velum/pharynx

Answer 5

CN IX and X
Nonspeech - gag
Speech - hyper or hypo nasal

Question 6

Assessing tongue

Answer 6

CN XII
Nonspeech - protrude/elevate tongue
Speech - articulation

Question 7

Assessing lips, face, teeth

Answer 7

CN VII
Nonspeech - smile
Speech - DDK

Question 8

Assessing jaw

Answer 8

CN V
Nonspeech - range of motion
Speech - bite block

Question 9

Foods to have available for hierarchy of bolus trials

Answer 9

Purée - applesauce/pudding
Solid - cookie
Thick liquid - pre thickened juice
Thin liquid - water 
Ice chips
Blue dye and colored food

Question 10

True/false: identification of aspiration is primary purpose of a VFSS

Answer 10

False

Question 11

True/false: neurological causes of dysphagia are not distinguishable by clinical and instrumental features of a swallowing disorder

Answer 11

True

Question 12

True/false: the VFSS can tell us not only is someone is aspirating but also impact of aspiration of overall health

Answer 12

False

Question 13

Strengths of a videofluroscopic swallow study (modified barium swallow)

Answer 13

Dynamic
Thorough
Unlimited review

Question 14

Limitations of VFSS

Answer 14

Exposure to radiation
Only a snapshot of functions
Abnormal environment

Question 15

View for a VFSS

Answer 15

Lateral
Frontal
Oblique

Question 16

Strengths of the FEES - fiberoptic endoscopic evaluation of swallowing

Answer 16

Excellent view of anatomy
Puriform sinues are visible 
No radiation
Can observe VFs
Observe ability to use airway closure maneuver 
Can see food residue

Question 17

Limitations of FEES

Answer 17

No oral stage swallowing
Not good for children/adults with cognitive issues
Discomfort
Abnormal environment 
Can't tell right from left

Question 18

View of FEES

Answer 18

Superior view

Question 19

What is the modified Evans blue dye test

Answer 19

Bedside procedure for the assessments of aspiration on patients with a tracheotomy

Can’t detect trace aspiration

Question 20

Procedure of Evans blue dye test

Answer 20

4 drops of blue dye on tongue, wait 4 hours
Monitor tracheal secretions for bluefish discolorations for 48 hours
Evidence of blue dye in tracheal secretions indicates aspiration
Perform routine tracheotomy care

Question 21

Components of a Evans blue dye test

Answer 21

Color liquids and solids with blue dye
Deflate cuff
Present bolus in order of difficulty
Suction after each consistency
Examined tracheal secretions for blue tint
Recommend diet

Question 22

Limitation of Evans blue dye test

Answer 22

Additional studies of it are warranted

Fails to detect aspiration - not sensitive enough

50% false error rate