Week 3 Flashcards
Screening ______ assesment
Does not equal
What is the purpose of a screening?
Determine which pts need an in-depth assessment
Screening can be done by
anyone (RN, MD most common)
When is screening typically conducted?
In high risk populations or settings
Most screening tools are designed to detect
overt aspiration (coughing)
What is done in the Yale Swallow Study
Uninterrupted drinking of 3oz (90 ml) of water by cup or straw
What denotes a fail in the Yale Swallow Protocol?
Cough (immediate or delayed)
Throat clear
Stop drinking
What are the limitations of the Yale Swallow Protocol?
Alot of water presented for risk of aspiration
Can’t detect silent aspiration
Not best indication of swallow
What is done in the Toronoto Bedside Swallow Screening Tool?
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)
What are limitations of the TOR-BSST?
Can not determine quality of airway protection
What does the EAT-10 assess?
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
What are limitations of EAT-10?
Pt must be cognitively intake with good language skills
What should be done before a CSE?
Cognitive screen
Commands (one-step)
OMSE
What are other names for CSE?
Bedside Swallow Evaluation
Clinical Bedside Swallow Evaluation
What is the goal of CSE’s?
Make perceptual judgement about pt’s safety and efficiency for eating and drinking by mouth W/O instrumental assessment
What are limitations of CSE?
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?)
What are the components of the CSE?
Medical/case Hx Swallowing history Physical exam and observations Food/liquid trials Documentation/plan
What is a sign?
Something tangible that you observe
ex. You hear pt cough after drinking/eating
What is a symptom?
Something the patient reports/ c/o
ex. Pt says “Food gets stuck when eating”
What information is needed for the medical case Hx?
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)
At first contact with the pt…
Get consent
- Confirm identity (check wristband)
- Explain who you are and why you are there
- Ask permission to assess swallow
What information is needed for swallow Hx?
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)
What information should be noted during the physical exam and observations?
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
What are reasons to wait to give trials?
NPO for other reasons (surgery)
Fluctuations in LOA
Respiratory/lung/trach status
Medical status
What are steps before you start swallowing trials?
- Consent
- Positioning (upright)
- Oral care
What liquids are more likely to cause pneumonia? Why?
Thick liquids
Harder for lungs to expel
What are signs of aspiration (safety)
cough
throat clear
wet voice
What are signs of post-swallow residue (efficiency)
multiple swallows
oral residue (look inside mouth)
Reduced hyolaryngeal excursion
What should hyolaryngeal palpation be used for?
Detecting presence of swallow
How many swallows per bolus completed
Time lapsed between bolus administration and pharyngeal swallow onset
What is hyolaryngeal palpation not accurate for?
Detecting delayed swallow initiation
Quantifying adequacy or anterior/superior hyolaryngeal movement
If there are no problems with thin liquids, should thick liquids be tested?
No, there is no reason
In what order should you test
Increasing difficulty
Ice chip tsp cup sip sequential drinking from cup straw drinking
In solids what should the order be tested?
Puree
Mechanically altered (fruit from fruit cup (not liquid))
Advanced (cookie/bread)
Mixed (fruit cup with liquid or cereal or soup)
