Week 3

Question 1

Screening ______ assesment

Answer 1

Does not equal

Question 2

What is the purpose of a screening?

Answer 2

Determine which pts need an in-depth assessment

Question 3

Screening can be done by

Answer 3

anyone (RN, MD most common)

Question 4

When is screening typically conducted?

Answer 4

In high risk populations or settings

Question 5

Most screening tools are designed to detect

Answer 5

overt aspiration (coughing)

Question 6

What is done in the Yale Swallow Study

Answer 6

Uninterrupted drinking of 3oz (90 ml) of water by cup or straw

Question 7

What denotes a fail in the Yale Swallow Protocol?

Answer 7

Cough (immediate or delayed)
Throat clear
Stop drinking

Question 8

What are the limitations of the Yale Swallow Protocol?

Answer 8

Alot of water presented for risk of aspiration
Can’t detect silent aspiration
Not best indication of swallow

Question 9

What is done in the Toronoto Bedside Swallow Screening Tool?

Answer 9

Judgement of voice before swallow (dysphonia = fail)

Tongue protrusion/lateralization (deviation or decreased ROM = fail)

Water swallow (10x1tsp - cough=fail)

Voice after swallow - wet=fail)

Question 10

What are limitations of the TOR-BSST?

Answer 10

Can not determine quality of airway protection

Question 11

What does the EAT-10 assess?

Answer 11

Self-report
Answer from 0>4 with 10 questions (0-no problem, 4-extreme problem)
Scores greater than 3 reflect swallow impairment and warrant SLP referral for indepth assessment

Question 12

What are limitations of EAT-10?

Answer 12

Pt must be cognitively intake with good language skills

Question 13

What should be done before a CSE?

Answer 13

Cognitive screen
Commands (one-step)
OMSE

Question 14

What are other names for CSE?

Answer 14

Bedside Swallow Evaluation

Clinical Bedside Swallow Evaluation

Question 15

What is the goal of CSE’s?

Answer 15

Make perceptual judgement about pt’s safety and efficiency for eating and drinking by mouth W/O instrumental assessment

Question 16

What are limitations of CSE?

Answer 16

Not good at identifying:

• physiological abnormalities of pharynx
• competence and quality of airway protection
• Silent aspiration
• How the solid and liquids are flowing (where are they going beyond the mouth?)

Question 17

What are the components of the CSE?

Answer 17

Medical/case Hx
Swallowing history
Physical exam and observations
Food/liquid trials 
Documentation/plan

Question 18

What is a sign?

Answer 18

Something tangible that you observe

ex. You hear pt cough after drinking/eating

Question 19

What is a symptom?

Answer 19

Something the patient reports/ c/o

ex. Pt says “Food gets stuck when eating”

Question 20

What information is needed for the medical case Hx?

Answer 20

Referral source
Medical chart
Medical professionals involved in the case
Pt & family

General info - Age, gender
Reason for admission, date of admission
Reason for referral
Current diet

Medical history - cardiac (general condition/fatigue, RLN issues?)

Pulmonary - past pneumonia? Airway status? Require O2? Method?

GI - GERD? Ulcers/bleeds?

Neurological - sensory/motor issues for swallow? Progressive conditions?

Otolaryngological - any issues relating to anatomy?

Oncological - past or current CA? treatment method for past CA?

Recent hospitalizations/surgeries

Prior speech/language/voice/swallow problems

Psychiatric HX

Social/cultural HX

Current meds (GERD, xerostomia, LOA)

Question 21

At first contact with the pt…

Answer 21

Get consent

• Confirm identity (check wristband)
• Explain who you are and why you are there
• Ask permission to assess swallow

Question 22

What information is needed for swallow Hx?

Answer 22

Method and schedule of eating
Diet (baseline and current)
Onset of problem
Description of problem
Compensation use (rate, consistency, posture?)
Variable characteristics of problem (consistency, temperature, meal duration, secretion management)

Question 23

What information should be noted during the physical exam and observations?

Answer 23

Body tone and positioning
Vocal quality
Baseline cough
Comprehension (Y/N questions, 1-2 step commands)
Self-feeding potential
General LOA
Attention/memory
O2 use or room air (not liters/min; facemask or nose prongs)
Trach/vent
Alternate feeding methods
dentures

Question 24

What are reasons to wait to give trials?

Answer 24

NPO for other reasons (surgery)
Fluctuations in LOA
Respiratory/lung/trach status
Medical status

Question 25

What are steps before you start swallowing trials?

Answer 25

1. Consent
2. Positioning (upright)
3. Oral care

Question 26

What liquids are more likely to cause pneumonia? Why?

Answer 26

Thick liquids

Harder for lungs to expel

Question 27

What are signs of aspiration (safety)

Answer 27

cough
throat clear
wet voice

Question 28

What are signs of post-swallow residue (efficiency)

Answer 28

multiple swallows
oral residue (look inside mouth)
Reduced hyolaryngeal excursion

Question 29

What should hyolaryngeal palpation be used for?

Answer 29

Detecting presence of swallow

How many swallows per bolus completed

Time lapsed between bolus administration and pharyngeal swallow onset

Question 30

What is hyolaryngeal palpation not accurate for?

Answer 30

Detecting delayed swallow initiation

Quantifying adequacy or anterior/superior hyolaryngeal movement

Question 31

If there are no problems with thin liquids, should thick liquids be tested?

Answer 31

No, there is no reason

Question 32

In what order should you test

Answer 32

Increasing difficulty

Ice chip 
tsp
cup sip
sequential drinking from cup
straw drinking

Question 33

In solids what should the order be tested?

Answer 33

Puree
Mechanically altered (fruit from fruit cup (not liquid))
Advanced (cookie/bread)
Mixed (fruit cup with liquid or cereal or soup)