Screening, instrumental and non-instrumental assessment of swallowing function Flashcards
Why is a bedside examination not useful with aspirating patients
A bedside examination is unable to identify the anatomic and physiologic causes of aspiration
(which, the information is needed for development of treatment plan)
What type of evaluation is used for a patient suspected of aspiration?
Radiographic evaluation
Why is a radiographic evaluation necessary?
- to identify the presence of aspiration
- define the etiology of the aspiration
- examine the immediate effects of selected treatment procedures and design appropriate therapy for the pt
- Determine the best method of nutritional intake
The MBS, FEES, and FEESST assessments are used to assess swallowing physiology for what purposes?
- identify aspiration, penetration, and/or residue patterns
- detect etiology (dysfunction structure)
- determine techniques, maneuvers, and consistencies that enhance swallowing safety and efficiency
Identify 5 implementations to enhance swallowing
- postural changes to change the dimensions of the pharynx and food flow (i.e., head turn)
- Increasing bolus sensory input (i.e., carbonation, ice)
- modify volume and speed of bolus presentation
- modify food consistency or viscosity
- use intraoral prosthetics
Identify 8 consistencies of bolus’ used?
- ice chips or lemon-ice
- thin liquids (water, mild, juice, formula)
- nectar (thick)
- honey (thick) or milkshake
- puree (pudding, apple sauce, yogurt)
- semisolid food (mashed potato, banana, pasta)
- Soft solid food that requires some chewing (bread and cheese, soft cookie, casserole, meat load, cooked veggies(
- Hard chewy crunchy food (meat, raw fruit, salad, soup with food bits, cereal with milk)
What are the 9 different bolus sizes used in swallowing examination
- <5cc (for medically fragile and poor pulmonary clearance pts)
- 5cc/1 teaspoon
- 10cc
- 15cc or 1 tablespoon
- 20cc or heaping table spoon
- single swallow from cup or straw-monitored
- single swallow from cup or straw self-monitored
- free consecutive swallows self-presented
- feed self food at own rate
8 recommendations following swallowing examination
- NPO
- swallowing therapy/biofeedback
- therapeutic feeding only with icechips with SLP
- feeding with liquid diet only
- feeding pudding consistency only
- continue with alternative feeding for nutritional and hydrational need: yes or no
- repeat examination
- consultation with ENT, GI, or Neurologist
Identify some dysphagia treatment techniques:
- sensory enhancement of food (taste, texture, temperature)
- range of oral motor exercises
- range of motion exercises for pharyngeal structures
- therapy with or without food
- thermal tactile stimulation
- shaker exercise
- jaw opening exercise
- chin tuck against resistance
- electrical stimulation
- mendelsohn
- head turn
- super-supraglottic swallow
- supraglottic swallow
- lee silverman voice treatment (LSVT)
- chin tuck
- swallow solutions
- IOP
- vital slim
- expiratory muscle strengthening therapy
What is the ultimate goal of evaluation? to answer what question/s
- Who, when, and how to treat?
- At what intensity to treat?
- How many repetitions in treatment?
- When should intervention be initiated in the course of a disease?
Three themes in treating dysphagia… what are they?
- Intensity: the amount of load, volume, and duration of exercise stimulus
- Specificity: how closely the exercise task corresponds to the targeted outcome
- Transference: implicated in the rationale for using cross-training and non-specific strength training to ultimately improve function
What factors should an SLP consider when choosing which evaluation procedure will be most appropriate for the pt?
-age
-language
-cognition
-medical diagnosis
Many evaluation techniques can be used concurrently… for example, MBS can be used with which two other instruments?
-MBS + manometer
-MBS + EMG
List the 5 imaging techniques for evaluation
- Ultrasound
- Videoendoscopy (FEES, FEESST)
- Videofluoroscopy (MBS, Pharyngogram)
- Barium Esophagram
- Scintigraphy
What information can be gathered when using imaging evaluation technique?
- Anatomy: structure presence/absence, symmetry
- Physiology: bolus flow characteristics, range/displacement and timing (biomechanics), residue patterns, airway protection (aspiration or penetration and pt reaction), sphincter valve function and timing, and displacement
- Identify aspiration or penetration
- Detect etiology
- Sensation
List 5 non-imaging techniques
- electromyography (EMG)
- Cervical auscultation
- Electroglottography (EGG)
- Pharyngeal and esophageal manometry
What information can be gathered when using non-imaging evaluation technique?
Function: identifies
-timing
-pressure
-neuromuscular patterns
-valve function
-sounds
What is Electromyography technique?
It includes what information?
Neuromuscular electrical activity recording
It includes…
1. detection
2. amplification
3. recording
4. processing and analysis
5. interpretation
There are three ways of recording the signals with electromyography, what is the most popular?
Surface electromyography (sEMG) is the most popular
Advantages of using electromyography (EMG)
-Sensitive to low amplitude muscular activity
-Non-invasive (surface electrode on FOM)
-Detects timing and amplitude of regional neuromuscular activity
Disadvantages of using electromyography (EMG)
-Non-specific (it records activity by region, not individual muscle)
-Invasive hook wire electrode-laryngeal UES
How does the manometry evaluation technique work?
-Uses a catheter that measures pressures at various intervals along the length of the esophagus
-Data on strength, timing, and sequencing of pressure events are obtained with each swallow
Using a manometer at evaluation can indicate?
- dysphagia
- non-cardiac chest pain in patients without evidence of mechanical obstruction, ulceration, or inflammation
Advantages of manometry
-tests pressure wave physiology
-sensitive to visually undetectable deficits (ex: like the failure of UES relaxation)
What is an actual test of pressure wave physiology
Manometry
How is high resolution manometry different from conventional manometry?
High resolution manometry 1. uses more pressure sensors
2. more accurate at assessing pressure changes
3. pressure sensors closer together (~1cm) compared to conventional manometry (~3 to 5cm)
4. Improves ability to diagnose esophageal motor disorders
5. Reduces movement artifact
6. Improves the detail of the acquired information
How is high-resolution manometry better at displaying and analyzing pressure change data?
Uses a esophageal pressure topography plot
What is an esophageal pressure topography plot?
- Seamless, dynamic representation of the entire pressure pattern, displaying pressure dynamics throughout the entire esophagus
-Obtains information regarding the anatomy, pressure gradients, and contractile activity
Disadvantages of manometry
- not widely available (but this is changing)
- can’t diagnose visible lesions
- unplesant
- technically demanding to perform
- Catheter movement
- no oral event
- few pharyngeal events
When may a manometry evaluation be indicated?
When patients need recurrent intraluminal pressure assessment for achalasia or diffuse esophageal spasm
What is Auscultation technique
Listening to the sounds of swallow and respiration using stethoscope
Advantages of auscultation technique?
- entirely non-invasive
- available
- portable
Disadvantages of auscultation technique?
- Lacks standardization
- lacks sensitivity and specificity
- subjective
- Somewhat controversial evaluation method
Advantages of using plain film imaging for evaluating dysphagia
Cheap and quick
Disadvantages of using plain film imaging for evaluating dysphagia
cannot detect mechanisms of the swallow