Lecture 6 Flashcards
What are the goals of instrumental assessment?
- Information on swallowing anatomy and physiology
- Evaluate the patient’s ability to swallow certain textures
- Assess adequacy of airway protection
- Evaluate impact of compensatory strategies
What are some advantages of instrumental assessment?
- Can more accurately determine if the patient is aspirating
- Gives more detailed information about the stages of the swallow
- We can observe if there is true airway protection or not (we can onlu hypothesise at bedside)
What are some disadvantages of instrumental assessment e.g. VFSS?
Expensive
Expose patient to radiation
Long waiting lists
When is instrumental evaluation indicated?
- Dysphagia characteristics are vague and require confirmation
- Safety or efficiency of swallowing is a concern
- Direction for rehab is needed
- Further detail required regarding underlying medical problems contributing to dysphagia
When is instrumental evaluation not indicated?
- When patient no longer has dysphagia complaints
- Patient is uncooperative to complete the procedure (e.g. TBI, dementia patients)
- If the results of the examination would NOT alter the clinical course or management plan
What is VFSS?
- Most commonly used instrumental assessment
- Studies captured using fluoroscopy that allows detailed analysis of the swallowing process
- Views: anterior posterior view (front on) and lateral view (side on). Aspiration, velopharyngeal seal, and hyolaryngeal excursion is most efficiently detected.
What happens in the VFSS procedure?
- Patient is positioned in sitting/standing position (may have to be different in stroke/spinal injury patients)
- Patient given a small amount of food/liquid mixed with barium and asked to swallow. Procedure is recorded.
- Thin liquid, thick liquid, puree, solid (in that order)
- Smaller to larger amounts (in that order)
Who should you refer to VFSS?
Clients with suspected or known dysphagia where the nature of the problem must be identified
Clients who are suitable for compensation/rehab
Where you suspect silent aspiration
Clients/families who would benefit from education regarding aspiration (i.e. not following diet recommendations)
Who should you NOT refer to VFSS?
When results are NOT expected to change management
When clients are confused/agitated/disoriented (e.g. dementia or TBI)
Depending on equipment, clients who are obese/problems with stability
What are some advantages of VFSS?
- More detailed analysis of swallow anatomy & physiology
- Shows penetration and aspiration
- Can review images in slow motion
- Assess duration of each phase
- Useful for ecudation/training packages
What are some disadvantages of VFSS?
- Still a fairly subjective measure
- Exposes patients to radiation
- Not truly representative of patients swallow - barium tastes bad and we only record a few swallows to minimise exposure to radiation
What should you look at when interpreting a VFSS?
- Ability to protect airway - is aspiration/penetration noted?
- Where was the swallow triggered from?
- Pharyngeal/oral residue
- Pharyngeal constriction and UES opening
- Tongue function in oral stage
What things should you look for specifically in the ORAL phase when interpreting a VFSS?
- Are the lips closed?
- Does the soft palate elevate?
- Is velopharyngeal seal achieved? Any nasal regurgitation?
- How was oral tongue function/bolus control?
- Did bolus enter pharynx prematurely?
- How efficient is tongue at propelling bolus into pharynx?
- Does the BOT meet the PPW?
What things should you look for specifically in the PHARYNGEAL phase when interpreting a VFSS?
- What is hyolaryngeal excursion like?
- How efficient is epiglottic deflection?
- Is pharyngeal constriction adequate?
- Was there aspiration/penetration? Was there an appropriate response to this (e.g. coughing)
- Any pharyngeal residue?
- Multiple swallows needed?
What things should you look for specifically in the OESOPHAGEAL phase when interpreting a VFSS?
- Did UES open? Enough?
- Was there reflux/regurgitation?
