CBSE and Screenings

Further assessment or referral is needed

True

Detailed description of subjective complaint or problem Acquisition of relevant health and medical history Clinical “bedside” observations (aka non instrumental) Physical examination of structures AND instrumental assessment

Amount given How it was presented Respirations and vocal quality at baseline and intermittently during assessment

They are able to identify those likely with dysphagia

False

Severe suspected dysphagia with poor tolerance of oral secretions or intraoral fluids (poor secretion management) pt. non-compliance poor level of alertness coughing/choking on certain consistencies of food/liquid with limited improvement from compensatory strategy use

Diet recommendations Things to monitor/aspiration precautions Proposed compensatory strategies If further testing is required Time frame for follow If further referrals are recommended

Economic status Cultural issues Education and employment Support system

They are able to screen those likely to not have dysphagia

It helps guide clinicians to find out client’s/caregiver’s major concerns and their impact on quality of life.

Past medical history (PMH) Current medical status and medications, pertinent diagnostic examinations: chest x-rays, head CTs, MRIs, etc Speech-language history, cognitive history, developmental history, psychosocial history, diet/nutritional history, general health, family history, voice changes Previous swallow evaluations? when? Pre-existing neurologic conditions Weight loss (esp. in recent 6 mos.)
Medications/recent changes in meds

Cervical Auscultation

False

True

Attention, concentration, mental status, ability to cooperate/participate - makes the difference whether a pt can safely consume a diet or not May not be aware of PO in the oral cavity, are impulsive when self-feeding, or talk with PO in oral cavity; may not be able to follow directions to use compensatory strategies; may not comprehend benefits/risks of eating which impacts therapy/education

ataxia, paralysis/paresis, use of non-dominant UE, eye/hand to mouth coordination • Sensation of food/liquid spill (ant./post.) Amount on spoon Amount gulped Missing food on one part of plate, tray (visual neglect, field cut, inattention) *work closely with OT for feeding techniques

OT, Dietician, Nurse, Medical specialists

Sit the patient upright at 80-90° (or as high as tolerated >30°). Ask the patient to drink the entire 3 ounces (90cc) of water from a cup or with a straw, in sequential swallows, and slowly and steadily but without stopping. (Note: Cup or straw can be held by clinician or patient.) Assess patient for interrupted drinking and coughing or choking during or immediately after completion of drinking

Observation of the patient and their environment Oral sensorimotor examination/oral peripheral exam/cranial nerve assessment MSD Screening (DDK, sustained /a/, volitional cough) Clinical hands-on swallowing examination Observation of eating

Often the team leader

To determine the likelihood of dysphagia, the need for further swallowing assessment, and the need for nutrition or hydrational support

To screen patients for dysphagia

Advanced age, diabetes mellitus, hypertension, atrial fibrillation, neurodegenerative disorders, cognition, and sarcopenia

A reliable, validated screening tool for adults and children

It is correlated to aspiration on VFSS

To obtain information on swallowing from the patient's perspective, guide clinicians to identify major concerns and their impact on quality of life, and understand the patient's wishes and preferences.

The maximum score attainable is 20 points, which indicates normal swallowing ability without overt aspiration risk.

The exclusion criterion is head bed restrictions of 30° or more.

The two parts of the GUSS are the Indirect swallowing test and the Direct swallowing test, which consists of 3 subtests.

The maximum points (5 points) must be attained to continue to the next subtest.

The purpose of the Yale Swallowing protocol is to assess swallowing function in patients and identify those at risk of aspiration.

The four levels of severity are: severe dysphagia and high aspiration risk (0-9 points), moderate dysphagia and moderate risk of aspiration (10-14 points), mild dysphagia with mild aspiration (15-19 points), and normal swallowing ability (20 points).

The EAT-10 is a self-administered questionnaire used to assess dysphagia and quality of life in patients.

The MDADI is a self-administered questionnaire used to assess dysphagia and quality of life in patients with head and neck cancer.

The primary outcome of a failed Yale Swallowing protocol is to keep the patient nil per os (NPO) and discuss with the medical team the need for an objective/instrumental swallowing evaluation.

To obtain a comprehensive, detailed history from various healthcare professionals and caregivers.

To identify pre-existing conditions that may exacerbate or alleviate swallowing problems.

To provide information about the severity and etiology of swallowing problems.

To identify potential risks for aspiration and nutritional deficiencies due to impaired cognitive function.

To provide general medical information about the patient, including vital signs and lab values.

Fluid management, as excessive fluids can exacerbate the condition.

To identify the presence or absence of a swallowing impairment and develop a personalized treatment plan.

To provide valuable information about the patient's swallowing function and daily living habits.

To evaluate the patient's ability to safely and effectively feed themselves.

To evaluate the impact of medications on swallowing function and identify potential risks for adverse reactions.

to “listen” to the sounds of the swallow and assess swallow sounds and airway sounds

ataxia, paralysis/paresis, use of non-dominant UE, eye/hand to mouth coordination, sensation of food/liquid spill, amount on spoon, amount gulped, missing food on one part of plate/tray

they provide detailed information about biomechanics and pathology, which is integrated with clinical observation and history to develop a comprehensive and efficacious management approach

to get the truest measure of their swallowing function

the clinical assessment of swallowing contributes to the ultimate diagnosis of the patient, but it is not sufficient to define swallowing pathophysiology, which requires instrumental exams

to develop a comprehensive and efficacious management approach

To rate a patient's own experience of 10 different possible swallowing problems.

To measure the impact of dysphagia on quality of life (QOL) and assess the patient's perspectives.

The scoring range is 0 (worst) to 100 (best), and a higher score indicates better quality of life.

To detect early dysphagia in patients with Parkinson's disease and other diagnoses.

To generate a hypothesis about swallowing function and screen for the presence or absence of swallowing impairment.

To obtain essential information for healthcare professionals to develop effective treatment plans.

They are complementary tools that can be used to assess treatment effectiveness and patient satisfaction, and improve quality of life and care for individuals with dysphagia.

It is indicative of oropharyngeal dysphagia.

To track progress and outcomes in dysphagia therapy.

To assess treatment effectiveness, patient satisfaction, and improve quality of life and care for individuals with dysphagia using tools like the SWAL-QOL and SWAL-CARE.

Optimal position is upright at 90 degree angle; Kyphotic or leaning to one side can affect swallowing.

To identify distractions, lighting, and other factors that may affect swallowing.

To identify labored, rapid, or shallow breathing and obtain baseline oxygen levels.

To assist with dietary needs and recommendations, including thickening of fluids and modification of food consistencies.

To identify potential cognitive impairments that may impact swallowing, such as neglect or inattention.

To assess a patient's ability to swallow safely and effectively, including oral motor skills and coordination.

To assess laryngeal elevation and coordination during swallowing.

To monitor oxygen saturation and heart rate during swallowing.

To identify potential difficulties with specific textures or consistencies and make recommendations for dietary modifications.

To assess the level of support and assistance provided by the caregiver and identify potential risks or barriers to safe swallowing.