Evaluation Flashcards
Aspects of a clinical evaluation/bedside swallow
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)
Assessing respiration (phonation)
Deep breath (Nonspeech) #syllables per breath (speech)
Functional components of an oral motor exam
Respiration (phonation)
Laryngeal (phonation)
Velum/Pharynx (phonation)
Tongue, lips, face, teeth, jaw (articulation)
Assessing laryngeal function
CN X
Nonspeech - cough and clear throat
Speech - loudness and sustained phonation
Assessing velum/pharynx
CN IX and X
Nonspeech - gag
Speech - hyper or hypo nasal
Assessing tongue
CN XII
Nonspeech - protrude/elevate tongue
Speech - articulation
Assessing lips, face, teeth
CN VII
Nonspeech - smile
Speech - DDK
Assessing jaw
CN V
Nonspeech - range of motion
Speech - bite block
Foods to have available for hierarchy of bolus trials
Purée - applesauce/pudding Solid - cookie Thick liquid - pre thickened juice Thin liquid - water Ice chips Blue dye and colored food
True/false: identification of aspiration is primary purpose of a VFSS
False
True/false: neurological causes of dysphagia are not distinguishable by clinical and instrumental features of a swallowing disorder
True
True/false: the VFSS can tell us not only is someone is aspirating but also impact of aspiration of overall health
False
Strengths of a videofluroscopic swallow study (modified barium swallow)
Dynamic
Thorough
Unlimited review
Limitations of VFSS
Exposure to radiation
Only a snapshot of functions
Abnormal environment
View for a VFSS
Lateral
Frontal
Oblique
Strengths of the FEES - fiberoptic endoscopic evaluation of swallowing
Excellent view of anatomy Puriform sinues are visible No radiation Can observe VFs Observe ability to use airway closure maneuver Can see food residue
Limitations of FEES
No oral stage swallowing Not good for children/adults with cognitive issues Discomfort Abnormal environment Can't tell right from left
View of FEES
Superior view
What is the modified Evans blue dye test
Bedside procedure for the assessments of aspiration on patients with a tracheotomy
Can’t detect trace aspiration
Procedure of Evans blue dye test
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
Components of a Evans blue dye test
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
Limitation of Evans blue dye test
Additional studies of it are warranted
Fails to detect aspiration - not sensitive enough
50% false error rate
