Week 3 - clinical decision making and dysphagia management

Question 1

What is presbyphagia?

Answer 1

• Ageing swallow
• Oropharyngeal muscle weakness
• Sensory dysfunction
• Affects normal swallowing and ability to differentiate taste

Question 2

What is odynophagia?

Answer 2

• Pain when swallowing
• Can occur with OR without dysphagia

Question 3

Describe a video fluoroscopy

Answer 3

• Dynamic, radiological assessment
• Identifies aspiration, penetration, any structural abnormalities
• Can try compensatory strategies during (eg. chin tuck, postural support, modification of bolus)

Question 4

What is aspiration?

Answer 4

• When bolus/liquid goes BELOW vocal cords
• v dangerous

Question 5

What is penetration?

Answer 5

• Bolus enters airway but remains above vocal cords
• Can be corrected by cough

Question 6

Name 7 factors to consider when using video fluoroscopy for dysphagia assessment?

Answer 6

1. Client level of consciousness/alertness
2. Ability/willingness to follow orders
3. Posture, balance (both sitting and standing)
4. Medical fitness (lifestyle/health risks)
5. Possibility for early spontaneous recovery (eg in acute stroke)
6. What is the impact of the information you will gain?
7. How will it change your management?

Question 7

True or false.. some authors believe that video fluoroscopy should be used with all patients

Answer 7

True

Question 8

Name 5 disadvantages of using video fluoroscopy

Answer 8

1. Can be expensive
2. Use of radiation limits frequency (for both client and clinician
3. Need trained SLTs to carry out (band 6/7)
4. Availability (only certain times and places, not mobile)
5. They are not always a reliable evaluation of swallowing function

Question 9

Describe a Fibreoptic Endoscopic Evaluation of Swallow (FEES)

Answer 9

• SLT inserts thin tube up patient’s nose with a camera and light on the end
• This allows us to view the pharynx, larynx, vocal cords during the swallow and monitor residue
• Nose can be sprayed with numbing solution before to reduce discomfort
• Food/liquids are often dyed to monitor residue

Question 10

What are 3 disadvantages of the Fibreoptic Endoscopic Evaluation of Swallow

Answer 10

• no info on the oral phase
• no info on pharyngeal delay or transit
• invasive/uncomfortable (some patients may not tolerate)

Question 11

What are three benefits of the Fibreoptic Endoscopic Evaluation of Sallow

Answer 11

• able to evaluate if compensatory strategies (chin tuck, double swallow etc) are effective
• provides accurate info on vocal fold movement
• can be used with OR without food
• can be left in place for a while (may be appropriate for patients who cannot tolerate transfer to a radiological suite for VF)

Question 12

What should your management be based on

Answer 12

SOLID assessment
(integrating data from range of sources)

Question 13

True or false.. it is important to take client preferences into account and have their agreement

Answer 13

True!

Question 14

When is nil by mouth considered

Answer 14

When the risks of aspiration are so great that the patient’s health is likely to be compromised by oral intake