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Dysphagia > Evaluation of Swallowing > Flashcards

Evaluation of Swallowing Flashcards

1
Q

What are the advantages of a swallowing screening?

A
  • quick
  • non-invasive
  • low risk
  • low cost
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2
Q

What are the components involved in a swallowing screening?

A
  • chart review
  • observation of 3 oz water test and timed swallow test
  • observe signs & symptoms
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3
Q

What is a false positive?

A

Id’d as aspirating but are not aspirating

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4
Q

What is a false negative?

A

Id’d as not aspirating but are

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5
Q

How accurate is the swallow screening?

A

Not 100% accurate, further assessment may be needed

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6
Q

Would an SLP rather have a false positive or a false negative?

A

False positive, error in the side of caution.

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7
Q

What are the various symptomatologies that might be seen with imaging diagnostic?

A
  • Valleculae hesitation/pooling
  • pyriforms pooling
  • UES dysfunction
  • Aspiration
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8
Q

Where does valleculae hesitation/pooling occur and what does the patient complain of?

A
  • Base of tongue/epiglottic area

- Sx: “stuck” high in throat

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9
Q

Where does pyriforms pooling occur and what symptoms do patients complain about?

A
  • Just below larynx

- Sx: “stuck” in the middle of throat

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10
Q

Where does UES dysfunction occur and what do patients complain about?

A
  • Pain in upper chest or inches below larynx

- Sx: “stuck” lower in throat or high in chest

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11
Q

What are signs and symptoms of aspiration?

A

-coughing and chocking

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12
Q

What is the percentage of people who have silent aspiration?

A

50%

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13
Q

What happens during silent aspiration?

A

There are no signs for the most part. No coughing or chocking. Eyes might start tearing and may have a runny nose (not often)/

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14
Q

What does the bedside clinical exam provide? (8 bullets)

A
  • medical dx, hx, pt perception
  • Pt medical status: nutritional tube? repiratory tube?ventilator?
  • Pts oral anatomy
  • Pt’s respiratory function
  • Control/fxn: labial, lingual, palatal, pharyngeal, laryngeal
  • cognitive status: comprehension, awareness
  • sensory: taste, temperature, texture
  • S/s during swallow attempts
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15
Q

Bedside clinical evaluation Book page:

A

139

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16
Q

What are the 11 materials used during the bedside clinical exam?

A
  • laryngeal mirror
  • tongue blades
  • cup
  • spoon
  • straw
  • syringe
  • towel/drape cloth
  • gloves
  • eye-wear/mask
  • stethoscope
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17
Q

What is involved during the prep of the bedside clinical exam: chart review?

A
  • Respiratory status & phase of respiration
  • dysphagia history
  • history of pneumonia
  • nutritional status
  • medications
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18
Q

When doing the chart review for the bedside clinical exam, what do you check for in respiratory status?

A
  • respiratory rate at rest
  • time saliva swallows & phase of respiration
  • time/gauge strength of cough
  • time apneic period: 1 sec, 3 sec, 5 sec
  • breathing pattern: mouth or nose
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19
Q

How many respiratory cycles should a normal person have in one minute at rest?

A

6 cycles; 10 second cycles

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20
Q

What should the SLP check for about dysphagia history during the chart review for the bedside clinical exam?

A
  • onset
  • symptoms
  • patient awareness
  • localization
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21
Q

What is a fever indicative of?

A

an infection

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22
Q

When checking for nutritional status on a chart review for a bedside clinical evaluation, what do you check for?

A
  • diet type
  • duration
  • tubed
  • adequacy
  • complications
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23
Q

What kind of medications do you look for during the chart review of the bedside clinical exam?

A
  • xerostomia
  • decreased alertness
  • delayed reaction time
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24
Q

What is involved in the phsysical exam of the bedside clinical exam?

A
  • posture
  • oral exam
  • laryngeal function exam
  • pulmonary function testing (PFT) if warranted
  • pneumotachometry (if warranted)
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25
Q

What are you checking during the anatomy part the oral exam during the bedside clinical exam?

A
  • lips
  • hard palate
  • soft palate
  • uvula
  • faucial arches
  • sulci
  • teeth
  • secretions
  • scarring and asymmetry
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26
Q

What are you checking for during the physiology part of the oral exam during the bedside clinical exam?

A
  • open mouth, stimuli (taste/texture/temp) chewing, sensitivity
  • labial function
  • lingual function
  • soft palate
  • apraxia
  • abnormal oral reflexes
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27
Q

What do you check for in labial function of the bedside clinical exam?

A

/i/, /u/, ddk /pa/, bilabial stops /p/, lips around object

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28
Q

What are the abnormal reflexes that are checked during the bedside clinical exam?

A
  • increased gag
  • tongue thrust
  • tonic bite
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29
Q

How is lingual function examined during the bedside clinical exam?

A
  • anterior: extension/retraction, corners of mouth, clear sulcus, tip to alveolar ridge & behind bottom teeth with open mouth, ddk /ta/, alveolar stops (t), rub along palate
  • posterior: back elevated /k/, ddk /ka/, velar stops (k)
30
Q

How is the soft palate tested during the bedside clinical exam?

A
  • sustain /a/
  • palatal reflex
  • gag reflex
31
Q

What is examined during the laryngeal function exam in a bedside clinical ex?

A
  • gurgly voice
  • hoarseness/breathiness: incomplete glottic closure
  • Ddk’s: neuro impairment
  • hard cough/strongh throat clear: reflexive/strong enough to clear
  • vocal scaling: cricothyroid muscle, SLN, intrinsics, decreased laryngeal sensitivity
  • phonation time (/s/ or/z/), decreased laryngeal control, decreased respiratory function?
32
Q

What are two methods of administering pulmonary function testing?

A
  • spirometry (FVC, FEV1)

- manometry (MIP, MEP)

33
Q

What should the SLP note for during the trial swallow?

A
  • pts reaction to food
  • oral movement (chewing, manipulation, propulsion)
  • coughing/throat clearing: before, during, after
  • secretion levels (check sulci)
  • Meal duration (if observed and amount)
  • resp/swallow coordination
  • hyolaryngeal excursion
  • sound of swallow
34
Q

When should you not attempt a trial swallow?

A
  • if acutely ill
  • decreased pulmonary function
  • very weak cough
  • 90 yo +
  • low cognition/awareness
  • suspect silent aspiration
35
Q

What should you administer to the patient during the trial swallows?

A

-use material that is easiest for patient to swallow (small quantity of 3cc/ml recommended)

36
Q

How can you check to listen if the swallow sounds normal?

A

Cervical auscultation

37
Q

What do you do during a cervical auscultation?

A

1) Place three fingers: one suprahyoids, 2: thyrohyoid, 3: cricothyroid
2) administer water, ask patient to hold
3) place stethoscope, ask pt to swallow

38
Q

How should a normal healthy swallow sound?

A

Nice clean clunky swallow

39
Q

What are some abnormal sounds?

A
  • white noise…dripping after

- residue leaking

40
Q

How can you check for a gurgly voice with auscultation?

A

Have pt say “ah” after swallow

41
Q

What should the bedside clinical/exam results show you?

A
  • posture resulting in best/safest swallow
  • best positioning for food in mouth
  • best food consistency
  • hypothesis as to nature of swallowing disorder
  • recommendation for dx (direct)
42
Q

Name the imaging diagnostic instrumentation used for dysphagia.

A
  • videofluroscopy (MBS)- Xray
  • FEES/FEESST/videoendoscopy (raw view)
  • ultrasound/fMRI/PET
  • scintigraphy
43
Q

Why is scintigraphy not used?

A

Because of radioactive exposure.

44
Q

What is the difference between FEES and FEEST?

A

-FEES: raw view

FEEST: sensory threshold, blows puff of air into larynx

45
Q

What happens if SLP doesn’t know what’s wrong after the MBS?

A

SLP cannot determine appropriate therapeutic techniques.

46
Q

Why is the radiologist present during the MBS?

A
  • To gage radiation safety)
  • Control on/off
  • zoom in, increases radiation exposure
47
Q

How does and SLP protect her/himself from the radiation?

A
  • Put lead vest on the front/back
  • thyroid wrap
  • student get behind lead screens
48
Q

What are the 6 indications of the MBS?

A
  1. to identify normal and abnormal A &P of the swallow
  2. TO evaluate airway protection before/during/after swallowing
  3. To evaluate the effectiveness of postures, maneuvers, bolus modifications, and sensory enhancements in improving swallowing safety and efficiency
  4. To provide recommendations regarding the optimum delivery of nutrition and hydration (oral vs nonoral)
  5. To determine appropriate therapeutic techniques
  6. To obtain information in order to collaborate with and educate other team members, referral sources, caregivers, and patients regarding recommendations for optimum swallow safety and efficiency.
49
Q

What are the 5 contraindications of the MBS?

A
  1. Medically unstable, lethargic, disoriented, agitated, uncooperative, cognitive deficits
  2. When the information obtained from the study is unlikely to change the patient’s management (advanced care preferences -DNR, chronic disease, or end-of-life situations)
  3. Patient is unable to be adequately positioned
  4. Size of patient prevents adequate imaging or exceed limit of positioning devices
  5. Allergy to barium (though this is quite rare)
50
Q

What are the limitations of the MBS?

A
  1. Time constraints due to radiation exposure
  2. As the procedure only samples swallow function, it does not fully represent mealtime function
    3.Contrast materials such as barium slightly increase and viscosity and alter liquid
    and solid food composition and are not natural foods-may result in discordance between the results of VFSS and real meals
  3. Limited ability to evaluate a fatigue effect on swallowing, unless specifically evaluated
  4. Barium is an unnatural food bolus with potential for refusal.
51
Q

Since the barium is an unnatural substance, what can it cause?

A

constipation

52
Q

What are the advantages of the MBS?

A
  • We can sell all the A&P
  • We can see all the stages
  • pretty quick
  • not very invasive, just x-ray
  • called the gold standard
  • we can test strategies, maneuvers, exercises to see if it improves swallowing.
53
Q

Which diagnostic instrumentation is called the gold standard?

A

MBS

54
Q

What are the advantages of FEES?

A
  • Examines A&P before and after swallow
  • no radiation exposure
  • no barium
  • excellent view of vf’s & larynx
  • quicker than MBS
55
Q

What structures can you observe with the FEES?

A
  • larynx
  • valleculae
  • pyriforms
  • real tissue
  • tongue balde
56
Q

What are the limitations of the FEES?

A
  • No oral or esophageal stages visible

- white out period during pharyngeal stage

57
Q

Why is the oral stage not visible during FEES?

A

Because it is being bypassed since your entering through the nasal cavity.

58
Q

Why can’t the SLP observe the esophageal stage with FEES?

A

It is beyond the scope of the SLP to push it in esophagus.

59
Q

What is examined during the ultrasound?

A
  • tongue function
  • oral transit time
  • hyoid motion
  • can’t imagine pharynx
  • oral stage only
60
Q

True/False: SLP can do ultrasounds

A

False

61
Q

Why is there a white out period during FEES?

A

The tongue base hits scope, hits pharyngeal wall.

62
Q

Name the non-imaging diagnostic instrumentation.

A
  • EMG (measures m. activity)
  • EGG (measures vf vibration at TH level)
  • Acoustics (accelerometer or stethoscope to listen)
  • Manometry (measures pressure)
63
Q

Nonimaging diagnostic instrumentation is mainly for _______.

A

research

64
Q

What does fMRI study?

A
  • Neural basis/mechanisms

- Neural mapping - cortical control

65
Q

What does PET instrumentation study?

A
  • neural activity associated with motion

- radiation exposure

66
Q

List the 5 major points of Scintigraphy.

A
  • Radioactive
  • gamma camera
  • amount of aspiration & residue
  • mouth & pharynx not well visualized-can’t id dysfunction
  • can’t diagnose esophageal (GERD)
67
Q

What consistency should you avoid during a diagnostic instrumentation?

A

Mixed consistency.

ex. fruit cocktail, cereal

68
Q

What does ASHA say about physicians being present during FEES?

A

In some states, physicians are required to be present during FEES.

69
Q

Are radiologists required to be present during the MBS?

A

Yes

70
Q

What consistency do you usually start with?

A

It depends on patient. Dr. Carmichael usually starts with thin liquids, do more than one trial.

71
Q

When assessing with an MBS, what questions do you need to answer?

A
  • What did you want to test?

- what consistency do you star with?

72
Q

Name the consistencies used to administer during an assessment.

A 
-thin liquid
thick liquid
-nectar thick
-honey thick
-thin pure
-thick pure
-mech soft
-chopped
-regular

Dysphagia (4 decks)

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