Instrumental swallow assessment Flashcards
Aims of VFSS (5)
- Evaluate biomechanical and physiological function of all phases of swallow
- Determine swallow safety/efficiency
- Identify effects of compensatory strategies, eg. posture modification
- Determine appropriate diet
- Assist in planning intervention
Barium for VFSS (6)
- Can alter taste and texture of trials
- Thickens liquids
- Masks taste
- Can increase likelihood of pharyngeal residue after swallow
- Can hide aspiration
- Important to standardise barium recipe
Radiation dose of VFSS
- 1/40 of annual exposure limit for client
Reduce your exposure
1. Time
2. Distance
3. Shielding
Clinical indications for VFSS
- Visualisation of oro-pharyngeal structures
- Assess airway protection
- Assess impact of therapeutic mechanisms
- Biofeedback
- Information for client/caregiver/professionals
- Contribution to diagnostic profile
Contraindications for VFSS
- Exposure to ionising radiation: pregnancy, allergive to barium
- Medical instability
- Transport, need to remain upright
- Cooperative and able
- Size of person
- NBM for any other reason than dysphagia
Advantages and disadvantages of VFSS
Advantages
- Real time visualisation of bolus path
- Visualisation of airway compromise and severity
- Can be used in patient education
Disadvantages
- Not a measure of overall function
- Can only be conducted in a clinical setting
- Requires barium
- Variability in interpretation
- Limited repetition
- Procedure generally not standardised
Standardising and interpreting VFSS
- Not standardised
- Get highest inter-rater reliability by discussing with other raters, having good quality video and slow video down
- Can use penetration-aspiration scale, Bethlehem aspiration scale
What is FEES?
- ‘Advanced practice’
- Endoscope through nasal cavity, past velopharyngeal border, into pharynx
- View of lower pharynx and pharyngeal vestibule
- See things can’t be seen on VFSS: oedema, growth, residue, reddening, etc
- Can be done for longer, eg. throughout a meal
- Can be done of a real meal, what client would eat rather than barium trials
- Can colour fluids for contrast and to see residue
FEES procedure
Pre-swallow
- Tip of endoscope is between soft palate and tip of epiglottis where entire larynx and pyriforms are visible
- Assessment of VF function
WHITE OUT during swallow, can’t see anything
Post-swallow
- Tip of endoscope is passed inferiorly into larynx so subglottis is seen, enabling detection of penetration and aspiration
Clinical indications for FEES
- History of pharyngeal dysphagia
- Difficulty managing secretions
- Difficulty coordinating swallow with respiration
- Abnormal vocal quality and suspected dysphagia
- Odynophagia (pain on swallowing)
- Globus sensations
Contraindications for FEES
- Severe agitation and reduced ability to cooperate
- Sever movement disorders
- History of vasovagal or fainting episodes
- History of severe epistaxis (nose bleeds)
- Nasal trauma or obstruction
- Recent head/neck cancer treatment
- Anticoagulation medication (nose blood)
- Nasopharyngeal stenosis (not wide enough)
- Base of skull/facial fracture
Advantages of FEES
- Direct observation of laryngeal vestibule
- Can make judgement regarding secretion management and reflux
- Accessible/portable
- Don’t need barium (expensive, taste/texture, availability)
- Can be repeated
- View mucosal integrity
- Could be less imposing for client
Disadvantages of FEES
- No view of oral phase (but can observe that from outside)
- Hyoid movement implied but not directly observed
- White out at height of swallow
- Can’t see aspiration as it happens
- Limited view of UES opening
