Non-instrumental swallow assessment

Question 1

Implications of dysphagia

Answer 1

• Malnutrition
• Dehydration
• Choking
• Partial obstruction
• Aspiration pneumonia
• Social isolation
• QOL impacts
• Economic reasons, length of hospital stay

Question 2

Dysphagia: oral phase (6)

Answer 2

• Anterior spillage
• Difficulty chewing
• Difficulty manipulating in mouth (how long are meals taking, fatigue?)
• Difficulty transferring bolus to pharynx cohesively/in one movement
• Bolus holding/pooling
• Pocketing of food in buccal cavities

Question 3

Dysphagia: pharyngeal phase (9)

Answer 3

• Can’t know for sure without instrumental testing but can hypothesise from OPE
• Delayed swallow initiation
• Reduced hyolaryngeal excursion
• Reduced pharyngeal contraction
• Reduced epiglottic deflection
• Reduced UES opening
• Residue in pharynx following swallow
• Penetration or aspiration
• Silent aspiration

Question 4

Dysphagia: oesophageal phase

Answer 4

• We don’t have a lot to do with this phase
• Reflux
• Food/fluid holding up in the oesophagus

Question 5

Components of a clinical bedside swallow exam (CBSE)

Answer 5

1. Review relevant referral information
2. Case history
3. Quality of life assessment (maybe)
4. OPE including cranial nerve as
5. Oral trials of food and drink

Question 6

1. Review relevant referral information: CBSE (3)

Answer 6

• Medical history
• Seek information directly pertaining to dysphagia
• Seek information indirectly pertaining to dysphagia, eg. medications, surgeries, co-morbidities

Question 7

2. Case history: CBSE (4)

Answer 7

• Onset of symptoms, progression, resolution of deficits
• Characteristics of dysphagia
• Food types associated with dysphagia
• Impact of dysphagia on person

Question 8

3. QOL assessment: CBSE (2)

Answer 8

• SWAL-QOL survey: 44 items, consider cognition/reading, 5-point scale answers
• EAT-10: shorter, self-administered, quick, easy to translate, good validity/reliability

Question 9

4. OPE: CBSE

Answer 9

Aims
1. Structural/functional integrity of articulators
2. Assess CN function
3. Assist in identifying MSDs
4. Determine areas for further assessment

Question 10

5. Oral trials: CBSE

Answer 10

Informs
- Ability to contain bolus in mouth
- Ability to manipulate/transfer bolus posteriorly
- Presence of hyolaryngeal excursion
- Effectiveness of oral clearance
- Recommendations for diet/fluid or NBM
- Identifies individuals who require instrumental assessment

Question 11

Limitations of CBSE (4)

Answer 11

• Helps to hypothesise physiology at best
• Poor sensitivity/specificity in identifying aspiration
• Environmental factors, eg. familiarity, distractions, posture/support, other restrictions
• Motivation