CBSE and Screenings

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A dysphagia screening test is a brief dysphagia assessment that helps determine if _____.

The client can safely intake PO
Further assessment or referral is needed (correct)
To diagnosis dysphagia
To diagnosis presbyphagia

The Yale swallow protocol is a clinician-facilitated screening tool.

True (A)

Comprehensive evaluation for dysphagia consists of a CBSE that includes:

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

During the CSE, a variety of textures/food items are provided. What are some important things to note?

Amount given How it was presented Respirations and vocal quality at baseline and intermittently during assessment Signup and view all the answers

Screenings have high sensitivity. What does this mean?

They are able to identify those likely with dysphagia Signup and view all the answers

The Eat-10 is clinician facilitated screening tool.

False (B) Signup and view all the answers

What are some reasons to terminate a bedside swallowing evaluation?

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 Signup and view all the answers

Upon completion of the CSE, what should be included in the recommendations?

Diet recommendations Things to monitor/aspiration precautions Proposed compensatory strategies If further testing is required Time frame for follow If further referrals are recommended Signup and view all the answers

What are 3 important factors to consider when obtaining psychosocial history?

Economic status Cultural issues Education and employment Support system Signup and view all the answers

Screenings have high specificity. What does this mean?

They are able to screen those likely to not have dysphagia Signup and view all the answers

Obtaining information on swallowing from the patient's perspective is essential information for healthcare professionals. Why?

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

Which items of information should be collected during a medical history for someone to be suspected with dysphagia?

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 Signup and view all the answers

This involves the use of a stethoscope, placed on the throat to “listen” to the sounds of the swallow.

Cervical Auscultation Signup and view all the answers

A CBSE allows an SLP to diagnose the presence of absence of a swallowing impairment.

False (B) Signup and view all the answers

The EAT-10 has been shown to predict the likelihood for aspiration in individuals who scores a 15 or more.

True (A) Signup and view all the answers

Cognition is often overlooked as a cause for aspiration risk or nutritional risk. How can cognition impact swallowing function?

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 Signup and view all the answers

It is important to assess a client’s self-feeding skills (when applicable). What should be observed?

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 Signup and view all the answers

What other professionals are involved in the management of dysphagia?

OT, Dietician, Nurse, Medical specialists Signup and view all the answers

What are the 3 steps to administer the Yale swallow protocol?

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 Signup and view all the answers

What are the 5 required components of a non instrumental swallowing evaluation?

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 Signup and view all the answers

What is the primary role of a speech-language pathologist in a dysphagia team?

Often the team leader Signup and view all the answers

What is the purpose of a dysphagia screening, according to ASHA?

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

What is the Repetitive Saliva Swallowing Test (RSST) used for?

To screen patients for dysphagia Signup and view all the answers

What are some common risk factors for disordered swallowing?

Advanced age, diabetes mellitus, hypertension, atrial fibrillation, neurodegenerative disorders, cognition, and sarcopenia Signup and view all the answers

What is the Yale Swallow Protocol, also known as the 3-ounce water test?

A reliable, validated screening tool for adults and children Signup and view all the answers

What is the significance of a patient's score on the Repetitive Saliva Swallowing Test (RSST) being less than 3?

It is correlated to aspiration on VFSS Signup and view all the answers

What is the main goal of the patient self-assessment questionnaires in dysphagia evaluation?

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. Signup and view all the answers

What is the maximum score attainable in the Gugging Swallowing Screen (GUSS) and what does it indicate?

The maximum score attainable is 20 points, which indicates normal swallowing ability without overt aspiration risk. Signup and view all the answers

What is the exclusion criterion for the Yale Swallowing protocol based on head bed restrictions?

The exclusion criterion is head bed restrictions of 30° or more. Signup and view all the answers

What are the two parts of the Gugging Swallowing Screen (GUSS)?

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

What is the minimum score required to continue to the next subtest in the Gugging Swallowing Screen (GUSS)?

The maximum points (5 points) must be attained to continue to the next subtest. Signup and view all the answers

What is the purpose of the Yale Swallowing protocol?

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

What are the four levels of severity of dysphagia determined by the Gugging Swallowing Screen (GUSS)?

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). Signup and view all the answers

What is the Eating Assessment Tool (EAT-10) used for?

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

What is the MDADI (M.D.Anderson Dysphagia Index) used for?

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

What is the primary outcome of a failed Yale Swallowing protocol?

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. Signup and view all the answers

What is the primary purpose of a team approach in CBSE?

To obtain a comprehensive, detailed history from various healthcare professionals and caregivers. Signup and view all the answers

What is the significance of collecting past medical history in a CBSE?

To identify pre-existing conditions that may exacerbate or alleviate swallowing problems. Signup and view all the answers

What is the role of radiographic examinations in a CBSE?

To provide information about the severity and etiology of swallowing problems. Signup and view all the answers

Why is it essential to assess cognitive history in a CBSE?

To identify potential risks for aspiration and nutritional deficiencies due to impaired cognitive function. Signup and view all the answers

What is the significance of nursing flowsheets in a CBSE?

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

What is the primary concern for patients with congestive heart failure in a CBSE?

Fluid management, as excessive fluids can exacerbate the condition. Signup and view all the answers

What is the purpose of a comprehensive bedside swallowing evaluation (CBSE)?

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

What is the role of the patient's roommates and family members in a CBSE?

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

Why is it essential to assess a patient's self-feeding skills in a CBSE?

To evaluate the patient's ability to safely and effectively feed themselves. Signup and view all the answers

What is the significance of medication management in a CBSE?

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

What is the purpose of using a stethoscope during a clinical assessment of swallowing?

to “listen” to the sounds of the swallow and assess swallow sounds and airway sounds Signup and view all the answers

What are some important signs to observe during a self-feeding assessment?

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 Signup and view all the answers

What is the significance of instrumental swallowing exams in developing a comprehensive management approach?

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

Why is it important to optimize a patient's medical or pulmonary condition before conducting an instrumental swallowing evaluation?

to get the truest measure of their swallowing function Signup and view all the answers

What is the relationship between the clinical assessment of swallowing and instrumental swallowing exams?

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 Signup and view all the answers

What is the primary goal of a comprehensive evaluation for dysphagia?

to develop a comprehensive and efficacious management approach Signup and view all the answers

What is the primary purpose of the EAT-10 in dysphagia therapy?

To rate a patient's own experience of 10 different possible swallowing problems. Signup and view all the answers

What is the SWAL-QOL used for in clinical research?

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

What is the scoring range for the SWAL-QOL, and what does a higher score indicate?

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

What is the Swallowing Disturbance Questionnaire (SDQ) used for?

To detect early dysphagia in patients with Parkinson's disease and other diagnoses. Signup and view all the answers

What is the primary purpose of the Clinical Bedside Swallow Evaluation (CBSE)?

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

What is the purpose of assessing the patient's perspectives in dysphagia therapy?

To obtain essential information for healthcare professionals to develop effective treatment plans. Signup and view all the answers

What is the advantage of using the SWAL-QOL and SWAL-CARE in dysphagia therapy?

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. Signup and view all the answers

What is the significance of a score of 3 or more on the EAT-10?

It is indicative of oropharyngeal dysphagia. Signup and view all the answers

What is the purpose of administering the EAT-10 every 60-90 days?

To track progress and outcomes in dysphagia therapy. Signup and view all the answers

What is the role of the speech-language pathologist (SLP) 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. Signup and view all the answers

What is the significance of assessing a patient's posture and movement during a non-instrumental swallowing evaluation?

Optimal position is upright at 90 degree angle; Kyphotic or leaning to one side can affect swallowing. Signup and view all the answers

Why is it important to assess a patient's environment during a non-instrumental swallowing evaluation?

To identify distractions, lighting, and other factors that may affect swallowing. Signup and view all the answers

What is the purpose of assessing a patient's pulmonary function during a non-instrumental swallowing evaluation?

To identify labored, rapid, or shallow breathing and obtain baseline oxygen levels. Signup and view all the answers

What is the role of the dietitian in the assessment and treatment of dysphagia?

To assist with dietary needs and recommendations, including thickening of fluids and modification of food consistencies. Signup and view all the answers

What is the significance of assessing a patient's cognitive function during a non-instrumental swallowing evaluation?

To identify potential cognitive impairments that may impact swallowing, such as neglect or inattention. Signup and view all the answers

What is the purpose of the clinical hands-on swallowing examination?

To assess a patient's ability to swallow safely and effectively, including oral motor skills and coordination. Signup and view all the answers

What is the significance of lightly palpating the thyroid prominence during the swallow trial?

To assess laryngeal elevation and coordination during swallowing. Signup and view all the answers

What is the purpose of using a pulse oximeter during the swallow trial?

To monitor oxygen saturation and heart rate during swallowing. Signup and view all the answers

What is the significance of assessing a patient's ability to handle different food consistencies during the clinical hands-on swallowing examination?

To identify potential difficulties with specific textures or consistencies and make recommendations for dietary modifications. Signup and view all the answers

What is the role of the caregiver-patient interaction during a non-instrumental swallowing evaluation?

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