Techniques for Evaluating Swallowing Flashcards
ON EXAM
What are some diagnoses at risk for dysphagia?
Neurological Events/Accidents (CVA, TBI, Craniotomy)
Neurological Diseases (PD, AD, ALS, MS, Huntington’s Chorea)
Head & Neck Cancer
Surgeries
Vocal Fold Problems
Elderly
History of Esophageal Problems
Cardiac Problems
Respiratory Problems (COPD)
What are some imaging techniques that can be used to assess for dysphagia?
Ultrasound
Scintigraphy
Videofluoroscopy/
Modified Barium Swallow Study
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
What are some non-imaging techniques to assess for dysphagia?
Electromyography (EMG)
Electroglottography (EGG )
Pharyngeal Manometry
Cervical Ausculation
Bedside/Clinical Swallow Evaluation
What is something you would NEVER state in your report if you give a non-imaging test
You would never say the patient is aspirating, because it’s a non-imaging technique! You say you suspect aspiration!!!!
Describe the Electromyography (EMG)-non imaging technique
A record of muscle activity from electrodes applied to that muscle.
Measures the amount of electrical energy generated by muscle contractions.
May be “surfaced” or “hooked-wire” EMG
Many times used in conjunction w/ an imaging technique.
Used as biofeedback for therapy for laryngeal elevation and “Hard/effortful” swallow.
Describe Electroglottography (EGG)
Reflects the amount of current flowing through the neck. When VF touch, more current flows.
Tracks VF movement by recording the impedance changes as the vocal folds move toward & away from each other during phonation.
Can be modified to track laryngeal elevation, which can be used to determine onset/termination of the pharyngeal swallow & extent/duration of laryngeal elevation.
Describe Pharyngeal Manometry
Uses solid-state pressure sensors (strain gauges) that reacts to rapid pressure changes during the pharyngeal swallow.
Sensors are encased in a 3-mm tube & inserted nasally w/ sensors:
- Tongue base pressure
- Crico-pharyngeal sphincter (Upper Esophageal Sphincter) pressure
- Cervical Esophagus pressure
Used in conjunction with video fluoroscopy.
Allows measurement of intrabolus pressures and the timing of the pharyngeal contractile wave.
Also used for indirect examination of the relaxation of the CP muscle by Identifying the drop in pressure at the CP sphincter in relation to the opening as seen via videofluoroscopy.
Used mostly in research.
Describe Cervical Auscultation–non-imaging technique
Utilizes the sounds of swallowing by placing a microphone or stethoscope to the neck area.
Listen for the “click” of the opening of the eustachian tube & “clunk” associated w/ CP opening for timing of the swallow.
Also use stethoscope for listening for respiration following the swallow
What information does a bedside/clinical swallow evaluation provide?
Info on medical dx/hx & h/o swallowing disorder including awareness of problem & indications of the localization & nature of the disorder.
Medical status including respiratory & nutritional status (ie., feeding tubes &/or other intubations).
Oral anatomy
Respiratory function & its relationship to swallow
Labial control
Lingual control
Palatal function
Pharyngeal wall contraction (scott disagrees)
Laryngeal control
General ability to follow directions
Reaction to oral sensory stimulation (taste, temperature, & texture)
Reactions/symptoms during attempts to swallow
What should we make sure to do during/before a bedside/clinical swallow eval?
Get a good history from the patient and/or caregiver.
Perform in as naturalistic environment as possible.
Perform an Oral mech. exam!!!!!!!!**SOOOOOO IMPORTANT**
Use a variety of texture/consistencies: - thin & thick liquids,
- pureed,
- wet soft (soup/fruit cocktail/cold cereal & milk),
- dry soft- bread,
- meat,
- dry-crumbly,
- pills.
- –hierarchy from thinnest to thickest…
Use adaptive or specialized equipment if necessary.
What should we look for during a Bedside swallow eval?
medical “red flags”
oral “red flags”
Pharyngeal “red flags”
esophageal “red flags”
What are medical red flags and where do you get this information from?
You get this from a chart review
Diagnoses
Signs/symptoms
Weight loss/nutritional status
Respiratory status
Cognitive/behavioral status
Need to be fed by caregiver (Langmore, S. et al. 1998)**#1*
Age/frailty
What are oral red flags?
Leakage of material out of mouth
Pocketing of material in oral cavity
Drooling
Labial/lingual weakness (need to always do an oral peripheral examination)
Sneezing
Runny nose
Spitting out of food
Difficulty taking material from utensil
What are Pharyngeal Red flags?
Coughing
Throat clearingeasily missed*
Wet/gurgly voice quality
Drop in O2 saturation level—anything below 90%
Temperature spike within 1 hour
Report of material “sticking”
Multiple swallows needed to clear material
What are esophageal red flags?
Globus sensation/referred pain
Belching
Heartburn
Material moving slowly downward
Acid taste in mouth
Coughing after eating/drinking
Coughing at night/while lying down
