Normal Swallow Flashcards
What would you do before a swallow assessment?
Gain informed consent
Take a case history (recent chest infections, recent weight loss, current medications, do you wear dentures)
Do you feel swallowing is more difficult/cough at certain times?
How do you eat (posture, environment)
How often are you coughing on food?
How often are you coughing on fluids?
How does it feel when you swallow?
Do you notice yourself doing multiple swallows?
Are you avoiding any food/drink, if so why?
Cranial nerve exam
Outline a cranial nerve exam
Assess motor nerve (V) through opening and closing of jaw and sensation to face
Assess facial (VII) through wrinkling forehead, puffing cheeks, rounding lips
Assess vagus (X) through dry swallow and cough
Assess hypoglossal (XII) through tongue movements
Describe things to consider in the preoral stage of a swallow
Is the patient self feeding or being fed?
What utensils are being used?
Environment
Senses – vision, smell
Positioning
Head position
Describe things to consider in the oral stage of the swallow
Jaw movement and control
Lip closure
Lateral chew?
Dentition
Pocketing in cheeks (check mouth to check all food is cleared)
Speed of oral phase
Sensory difficulties (residue on the lips that is not cleared, etc)
Things to consider in the pharyngeal stage of the swallow
Overt signs of aspiration (wet voice, straining, tears colour change)
Coughing/choking
Speed and effectiveness of swallow initiation
Multiple swallows?
Respiratory difficulty (oxygen saturation)
Sensation of food “sticking”- if so, where?
Palpation
Auscultation
Fatigue after swallow
Outline an entire swallow assessment
Case history
Cranial nerve exam
Swallow assessment using food
Swallow assessment using fluids
IDDSI level zero?
Thin
IDDSI level 1
Slightly thick
IDDSI level 2
Mildly thick
IDDSI level 3
Moderately thick (fluids)
Liquidised (foods)
IDDSI level 4
Puréed
IDDSI level 5
Minced and moist
IDDSI level 6
Soft and bite-size
IDDSI level 7
Regular
Easy to chew
What are transitional foods
Foods that change textures when heat or moisture is applied i.e. ice cream
What is eating and drinking with acknowledge risks?
Eating and drinking with acknowledged risks is the choice to continue eating and drinking despite the knowing associated risks from having Dysphagia. Risks such as aspiration, malnutrition, dehydration, and choking.
When may people choose to EDAR
People may choose to eat and drink with acknowledged risks if:
They have full capacity and continue to eat and drink despite risks
They have full capacity and decline modified diet
They are in end of life care and the focus is maximising quality of life
They are meeting their nutritional requirements through clinically assisted nutrition and hydration and wish to eat/drink for pleasure
An individual who lacks capacity not suitable for clinically assisted nutrition and hydration and the enjoyment of eating and drinking outweighs the risks associated with aspiration pneumonia
Give an example of when EDAR may be appropriate
Patients with severe dementia in end of life care
Patient with LD where clinically assisted nutrition and hydration is not suitable, and eating and drinking enhances quality of life
What is the decision-making process for EDAR
1- clinical swallow assessment
2-assess capacity
3-established goal of intervention/care with the individual or next of kin
4-facilitate communication with the MDT
5-set out an advance care plan (if appropriate)
If an individual lacks capacity to make decisions regarding EDAR, what are the next steps?
Multidisciplinary decision-making in the individuals best interests
Must engage those caring for the person, close to the person (NOK) or a designated advocate
All information should be presented in accessible way allowing time for reflection and questions
What is the MDT associated with EDAR
The individual themselves
Family member/NOK/carer
Medical practitioner
SLT
GP
Dietician
? Physiotherapist
? Nurse
? Healthcare care
? Palliative care where necessary
Describe the normal swallow
Food and drink brought into the mouth
Lips and jaw close to seal food in the oral cavity
Food processed to form a bolus
Tongue pushes bolus to the back of the mouth and into the pharynx
Voluntary swallow initiated
Bolus propelled through pharynx and into upper oesophageal sphincter
Epiglottitis and vocal folds cloës to block off the airway
Bolus passes through lower oesophageal sphincter into the stomach
Why palate a swallow?
Palpation allows for feeling of the hyoid moving up and out during the swallow
Feeling for reduced hyoid elevation
speed of swallow
Multiple swallows
As this could indicate abnormal swallow
Why auscultate a swallow?
Allows for identification of sound that may indicate an abnormal swallow
Such as wet or gurgly swallow
Multiple swallows
Speed of swallow
?Residue
