Assessment of Dysphagia: Difference between revisions

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* Helps to identify the risk of aspiration <ref name=":0" />
* Helps to identify the risk of aspiration <ref name=":0" />
* Used by SLPs to provide feeding recommendations
* Used by SLPs to provide feeding recommendations
* Consists of the following steps:
'''Standardised Protocol for BSE evaluation include the following elements:'''<ref name=":0" />
** comprehensive patient's history
 
** detailed physical examination of the structure and function of the oropharyngeal musculature (including sensory and motor cranial nerve examination)
* review of the patient’s medical record
** assessments of the patient’s ability to swallow foods and liquids of different volumes and consistencies.
* physical examination:
** lip movement and seal
** tongue movement and strength
** volitional cough strength
** dentition
** voice quality
** amount of assistance required with feeding
* patient is positioned as upright as possible
* The SLP administered five standard consistencies: (1) ice chips, (2) nectar thin liquids, (3) pureed solids , (4) thin liquids, and (5) solids in successive boluses that increased in size
* The SLP administers all boluses ''unless'' they consider it unsafe based on the patient's response
* The SLP observes for five clinical signs for aspiration after each bolus: cough, throat clearing, change in vocal quality, wet breath sounds, or stridor.  


=== Swallowing Reflex Test (Cough Reflex Test) ===
=== Swallowing Reflex Test (Cough Reflex Test) ===
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=== Fiberoptic Endoscopic Evaluation of Swallowing (FEES) ===
=== Fiberoptic Endoscopic Evaluation of Swallowing (FEES) ===
* administered by '''SLPs trained in FEES examination'''
* fiber-optic or distal chip endoscopes are used for the evaluation
* every institution must develop protocol for FEES administration
* video and sound is recorded and use to determine a penetration-aspiration scale (PAS) score for each of the boluses administered
** PAS is 8-point, equal-appearing interval scale describing penetration and aspiration events <ref>Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8.</ref>


== Resources  ==
== Resources  ==

Revision as of 14:38, 17 June 2024

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Introduction[edit | edit source]

Patient History[edit | edit source]

Observation[edit | edit source]

Palpation[edit | edit source]

Examination[edit | edit source]

General Rules[edit | edit source]

Dry Swallowing[edit | edit source]

Water Swallowing Test[edit | edit source]

Modified Water Swallowing Test[edit | edit source]

Bedside Swallowing Evaluation (BSE)[edit | edit source]

  • Completed by the speech language pathologists (SLPs)
  • Assess swallowing function and airway safety during swallowing[1]
  • Helps to identify the risk of aspiration [1]
  • Used by SLPs to provide feeding recommendations

Standardised Protocol for BSE evaluation include the following elements:[1]

  • review of the patient’s medical record
  • physical examination:
    • lip movement and seal
    • tongue movement and strength
    • volitional cough strength
    • dentition
    • voice quality
    • amount of assistance required with feeding
  • patient is positioned as upright as possible
  • The SLP administered five standard consistencies: (1) ice chips, (2) nectar thin liquids, (3) pureed solids , (4) thin liquids, and (5) solids in successive boluses that increased in size
  • The SLP administers all boluses unless they consider it unsafe based on the patient's response
  • The SLP observes for five clinical signs for aspiration after each bolus: cough, throat clearing, change in vocal quality, wet breath sounds, or stridor.

Swallowing Reflex Test (Cough Reflex Test)[edit | edit source]

Videofluoroscopic Swallow Study (VFSS)[edit | edit source]

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)[edit | edit source]

  • administered by SLPs trained in FEES examination
  • fiber-optic or distal chip endoscopes are used for the evaluation
  • every institution must develop protocol for FEES administration
  • video and sound is recorded and use to determine a penetration-aspiration scale (PAS) score for each of the boluses administered
    • PAS is 8-point, equal-appearing interval scale describing penetration and aspiration events [2]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors. Chest. 2020 Nov;158(5):1923-1933.
  2. ↑ Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8.
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