Instrumental assessment

Question 1

Goals of instrumental assessment

Answer 1

• gives info on the swallow anatomy and physiology
• evaluate the ability of the person to swallow various materials
• assess secretions and the person’s ability to manage them
• assess the adequacy of airway protection and coordination of breathing and swallowing

Question 2

what is Videofluoroscopic Swallow Study (VFSS)

Answer 2

Provides detailed information about the anatomy, physiology & timing of the swallow

• “Gold standard” for dysphagia evaluation
• Offers information about the effectiveness of compensatory & therapeutic techniques
• Shows penetration & aspiration.

Question 3

What do you see from the lateral view of a VFSS

Answer 3

• Acceptance of the bolus / oral preparation
• Movement of the soft palate – velopharyngeal seal
• Movements of hyolaryngeal excursion & epiglottic deflection well distinguished
• Residue evident (difficult to tell whether bilateral or not)
• View the larynx, vocal folds & trachea

Question 4

What do you see from the anterior view of a VFSS

Answer 4

• Alignment of mandible
• Symmetry of pooling in the oral cavity
• Asymmetry of vocal fold movement
• Residue (e.g. collection in the valleculae / pyriform sinus – compare left & right).

Question 5

Disadvantages of VFSS

Answer 5

• Radiation exposure
• Barium affects taste, texture & density (barium is a solid and increases weight of what it is added too)
• VF not really representative of normal meal time. Clinical setting, only a snap shot. May not get to see fatigue over a mealtime
• Not able to assess ‘sensory’ aspects very well… Can make inferences!
• Not always accessible – rural settings; wait lists…
• Fairly costly

Question 6

Advantages of VFSS

Answer 6

• Provides view of oral & pharyngeal structures
• Can assess the duration of each phase
• Gives information about safety of different foods / fluids and/or compensation & rehabilitation techniques
• Can quantify aspiration
• Can review images in slow motion!

Question 7

What is a FEES

Answer 7

Fibreoptic Endoscopic Evaluation of Swallowing

Endoscope passed transnasally to provide direct visualisation of the swallowing anatomy

Question 8

Advantages of FEES

Answer 8

• Portable/bedside
• Reduced cost
• Uses real food/drink
• Ease of repeat procedure
• Direct assessment of the larynx and secretion management

Question 9

Limitations of FEES

Answer 9

• “White out” at height of swallow
• Evidence of aspiration ‘assumed’ not observed
• Can’t quantify aspiration
• Can’t view the oral or oesophageal phase
• Client needs to be cooperative and follow instructions

Question 10

Pulse Oximetry

Answer 10

• Measures amount of oxygen being carried in the bloodstream, given as a percentage
• Some interest in oxygen saturation levels providing an indicator of an aspiration event

Question 11

Cervical Auscultation

Answer 11

• Place a stethoscope on the patients throat and listen for the larynx
• CA can’t be used diagnostically