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Dysphagia > Lesson 3-Instrumental Assessments > Flashcards

Lesson 3-Instrumental Assessments Flashcards

1
Q

Instrumental Techniques

A 
MBSS
FEES
Cervical auscultation
Scintingraphy
    *EMG and Ultrasound*
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2
Q

MBSS

A

videoflurographic study
only exam that can determine presence/absence of aspiration and it’s cause
uses barium paste

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3
Q

Consistencies tesed in MBSS

A

solid, pudding, honey, nectar, thin

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4
Q

MBSS Pros

A 
determination of aspiration
cause of aspiration
therapeutic
allows esophageal examination
objective
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5
Q

MBSS Cons

A 
medically fragile
obesity
special chair
radiation exposure
barium, not real food
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6
Q

FEES

A

assessment that involves thin, flexible fiberoptic telescope via nose to pharynx

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7
Q

What can be visualized with FEES?

A

pooling, laryngeal penetration, aspiration, reflux

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8
Q

FEEST

A

state of the art non-radioactive alernative to barium swallow studies. allows for direct assessment of the motor and sensory aspects of the swallow in order to precisely guide the dietary and behavioral managment of patients with swallowing problems

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9
Q

Advantages of FEES

A

Can be done bedside, same day
dx suspected laryngeal pathology
great view of laryngeal/pharyngeal structures
real foods/liquids
no radition exposure
can perform longer exam
**effects of fatigue & effectiveness of postures/maneuvers

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10
Q

Limitations of FEES

A 
cannot see oral or esophageal stage
period of white out during swallow
cannot detect aspiration DURING swallow
uncomfortable
not for every patient
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11
Q

Contraindications and Risks of FEES

A

bleeding disorders
Hx of fainting
Acute cardiac problems (bradycardia–reduced heart rt)

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12
Q

Adverse Reactions with FEES

A 
discomfort
bleeding
reaction to anesthesia
laryngospasm (VC adductor spasm)
Vasovagal response- bradycardia dn syncope
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13
Q

FEES equipment

A 
3.5mm flexible endoscope
powerful xenon light source
5-lux CCD miniature camera
Lens adapter
high resolution color monitor
s-VHS VCR
lapel microphone for recording exam commentary
color printer
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14
Q

Components of FEES exam

A

VP closure

observation of hypopharynx, oral/pulmonary secretions, laryngeal structures

test airway protection (cough, hold breath, hold breath tightly)

test phonation (ah, ee, he he, 1-10, ah for 7 secs, ee in high pitch)

consistencies

Sensation?

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15
Q

Cervical Auscultation

A

listening to tracheal breath sounds via stethoscope

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16
Q

Splainguard 1986 Research of bedside evals

A
  • Bedside eval followed by MBSS w/in 72hrs
  • Criteria for aspiration: respiratory distress, coughing, choking, tracheal secretions, wet voice quality
  • Results: only 40% of aspirators were identified…25 w/ silent aspiration not identified
17
Q

Pam Zenner 1995 Research of bedside eval + cervical auscultation

A

Results: 84% of aspirators were identified
Criteria for aspiration:
stridor, escalation of respiratory rate, coughing/choking, wet breath sounds, wet vocal quality, flushing sound prior to swallow, no apnic period w/ swallow, inhalation after swallow

18
Q

Additional Research regarding cervical auscultation by Stroud examined…____ and ___ reliability

A

inter
intra-rater
Results:fair agreement, over detection of aspiration, increased understanding of the interpretation of the sounds may improve reliability

19
Q

What does research tell us about cervical auscultation?

A
  • clinicians need to be VERY experienced & may still over detect
  • may not be reliable enough when it come to aspiration
20
Q

What CAN we reliably expect from adding cervical auscultation to our bedside exam?

A

can give additional info about the swall that is helpful in managment

21
Q

Advantages of Cervical Auscultation

A 
helps ID aspiration
non invasive
no raditation
inexpensive
easilty added to clinical exam
22
Q

Disadvantages of Cervical Auscultation

A

lack of research
observer variability
Does not ID problem (reason for aspiration, timing of aspiration)

23
Q

Apnea during Cervical Auscultation

A

85-95% of all adults demonstrate a swallow during the exhalation phase of respiration

there is a distinguishable apnic period during the swallow

24
Q

Indications of Abnormality during Cervical Auscultation

A 
Apnic period begins earlier in the swallow
longer apnic phase
swallow begins in the inspiratory phase
inspiration occurs after the swallow
inconsistent respiratory pattern
wet breath sounds
25
Q

using apnic period to determine potential dysphagia

A

mild dysphagia 1.315 secs

severe dysphagia 1.795

26
Q

cervical auscultation practical application

A

listen for apnic period
listen for breath pattern after swallow
listen for adventitious sounds..gurgling, wet vocal quality, etc

27
Q

Scintigraphy

A

nuclear medicine test

pt swallows measured amts of radioactive substance

bolus imaged & tracked by gamma camera

residue & aspiration can be measured

not helpful in assessing cause of aspiration/dsyfunction

helpful in the study of GERD

currently used for research only

Dysphagia (8 decks)

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