Midterm Flashcards
List the two components of an evaluation of swallowing
Clinical assessment Instrumental assessment (includes videofluoroscopy and endoscopy)
Describe the purpose of the clinical examination
Provides a comprehensive profile of the patient
Interview patient and caregivers
Examine speech/swallow components
Observe what happens when the patient is fed
Provides an opportunity to teach potential compensations
Helps to tailor the instrumental examination
What structures are included in a visual inspection of the oral cavitiy
Lips, sulci, gums, dentition, faucial pillars, roof of mouth, tongue, posterior pharyngeal wall
List functional components assessed in swallow eval
Respiratory mechanism, laryngeal mechanism, velum/pharynx, tongue, lips/face/teeth, jaw
What should be included in a bedside assessment?
Interview patient and caregivers
Examine speech/swallow components
Observe what happens when the patient is fed
Teach potential swallowing compensations
What are some limitations of the clinical examination?
38 - 40% of patients who aspirate are not identified on clinical examination Logemann, Lazarus & Jenkins, 1982
Pharyngeal events are not observable
Basis for aspiration cannot be determined
What two methods have been used in addition to clinical assessment?
Modified blue dye test
Pulse oximetry test
What is the “philosophy” of instrumental assessment?
Flexible protocol or routine Tailored examination Medical status of patient Initial vs follow up study “Therapeutic” study Safest bolus first Predict diet based on bolus types
Provide some diagnostic challenges of instrumental assessments
Unreliable information Compromised communication skills Lack of awareness Lack of cooperation Unaware and/or uninvolved surrogate Denial and accomodation “Normal aging” myth
List potential causes of silent aspiration
Brain stem CVA Desensitization Tracheostomy Medications Decreased level of arousal
You can tailor instrumental assessments based on what features
Medical history
Interview
Speech/oral motor examination
Bolus trials
What questions should you ask when planning the VFSS?
What are the implications of impairments of each functional component?
How should I start—bolus consistency, amount, delivery method?
What compensations do I anticipate using?
What are the objectives of the VSS?
Obtain an image of anatomy and physiology relevant to swallowing
Identify abnormalities of anatomy and physiology relevant to swallowing
Assess individual’s ability to swallow different consistencies safely and efficiently
What are the objectives of the VSS?
Obtain an image of anatomy and physiology relevant to swallowing
Identify abnormalities of anatomy and physiology relevant to swallowing
Assess individual’s ability to swallow different consistencies safely and efficiently
Determine the need for and direction of swallowing rehabilitation and/or need for other consultations
Assess benefit of swallowing tx
Assess benefit of compensatory strategies
Obtain an objective and permanent record of swallowing status
List indications for the VFSS
When a swallowing disorder is suspected, or if an individual is at high risk for dysphagia
When the clinical examination is insufficient to answer relevant questions
When nutritional and respiratory issues are of concern
When the medical diagnosis is not established
When the direction for swallowing rehabilitation needs to be established
