Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Assessment of Dysphagia


Clinical Assessment of Dysphagia

 

 

Ideally, before assessing a client’s swallow, a detailed case history, review of medical records and possibly an interview with the patient or family would be appropriate. This would provide the clinician with information regarding nutrition, weight loss, dentures, cognitive changes, recurrent pneumonia, among other things. In addition, the clinician should also:

 

Ask the patient if they have noticed a change in their swallow, if so, then what?

Conduct an oral mechanism examination

Possibly clean the patient’s mouth out

Look at facial symmetry and function of structures- teeth, velum, tongue, jaw, lips, cheeks

Quick check of cognition- orientation to place and situation, where they’re from, etc.

Dry swallow- baseline- should be able to do 3 or 4 normally- look at timing

Liquids- look for closure of lips, buccal tension, mandible alignment, swallow initiation (delayed or timely), laryngeal elevation (through palpation), cough, throat clear, change in vocal quality (wet), running nose, eyes watering and residue in mouth. If patient is on nectar or honey thick liquids try the next thinner liquid if the current is well tolerated. For example, if currently on honey thick then evaluate patient’s toleration of nectar. If nectar is tolerated well, then try thin liquid.

Solids- look at preparation of bolus (mastication, mandible alignment, lip closure, buccal tension), swallow initiation (delayed or timely), laryngeal elevation (through palpation), cough, throat clear, vocal quality change, pocketing, and residue in mouth. If patient is on restricted diet such a puree and is tolerating it well, assess patient’s toleration of pudding thick or mech soft and maybe even with solid food if the above are well tolerated.

If appropriate suggest other tools of assessment such as:

Fiberoptic Endoscopic Evaluation of Swallow (FEES)- a flexible fiberoptic endoscope (a small video camera) is passed transnasally into the hypopharynx. It allows direct observation of the pharyngeal and laryngeal structures during swallowing so that clinician can view structural abnormalities, timing of initiation, premature spillage, pooling, penetration, aspiration, residue etc. This enables the SLP to suggest diet changes, swallowing maneuvers, or postural changes to improve function of swallow.

Videofluoroscopic Assessment (Modified Barium study)- a radiologic method of examining movement of internal structures and recording the movement patterns. It is useful in assessing oral preparatory, oral phase, pharyngeal phase and esophageal phase, which includes tongue and jaw movement, velopharyngeal mechanism, vocal folds, laryngeal elevation, etc. A modified barium study allows x-ray observation from multiple views (frontal, lateral, base and oblique) of structural abnormalities, timing of initiation, premature spillage, pooling, penetration, aspiration, residue etc. This test also enables the SLP to suggest diet changes, swallowing maneuvers, or postural changes to improve function of swallow.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: