Lesson 3-Instrumental Assessments Flashcards
Instrumental Techniques
MBSS
FEES
Cervical auscultation
Scintingraphy
*EMG and Ultrasound*MBSS
videoflurographic study
only exam that can determine presence/absence of aspiration and it’s cause
uses barium paste
Consistencies tesed in MBSS
solid, pudding, honey, nectar, thin
MBSS Pros
determination of aspiration cause of aspiration therapeutic allows esophageal examination objective
MBSS Cons
medically fragile obesity special chair radiation exposure barium, not real food
FEES
assessment that involves thin, flexible fiberoptic telescope via nose to pharynx
What can be visualized with FEES?
pooling, laryngeal penetration, aspiration, reflux
FEEST
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
Advantages of FEES
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
Limitations of FEES
cannot see oral or esophageal stage period of white out during swallow cannot detect aspiration DURING swallow uncomfortable not for every patient
Contraindications and Risks of FEES
bleeding disorders
Hx of fainting
Acute cardiac problems (bradycardia–reduced heart rt)
Adverse Reactions with FEES
discomfort bleeding reaction to anesthesia laryngospasm (VC adductor spasm) Vasovagal response- bradycardia dn syncope
FEES equipment
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
Components of FEES exam
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?
Cervical Auscultation
listening to tracheal breath sounds via stethoscope
Splainguard 1986 Research of bedside evals
- 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
Pam Zenner 1995 Research of bedside eval + cervical auscultation
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
Additional Research regarding cervical auscultation by Stroud examined…____ and ___ reliability
inter
intra-rater
Results:fair agreement, over detection of aspiration, increased understanding of the interpretation of the sounds may improve reliability
What does research tell us about cervical auscultation?
- clinicians need to be VERY experienced & may still over detect
- may not be reliable enough when it come to aspiration
What CAN we reliably expect from adding cervical auscultation to our bedside exam?
can give additional info about the swall that is helpful in managment
Advantages of Cervical Auscultation
helps ID aspiration non invasive no raditation inexpensive easilty added to clinical exam
Disadvantages of Cervical Auscultation
lack of research
observer variability
Does not ID problem (reason for aspiration, timing of aspiration)
Apnea during Cervical Auscultation
85-95% of all adults demonstrate a swallow during the exhalation phase of respiration
there is a distinguishable apnic period during the swallow
Indications of Abnormality during Cervical Auscultation
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
using apnic period to determine potential dysphagia
mild dysphagia 1.315 secs
severe dysphagia 1.795
cervical auscultation practical application
listen for apnic period
listen for breath pattern after swallow
listen for adventitious sounds..gurgling, wet vocal quality, etc
Scintigraphy
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
