Instrumental Evaluation

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What is the definition of a VFSS?

Quick and reliable method to identify stroke patients with dysphagia and aspiration risk

Dynamic fluoroscopic image of moving bolus and oropharyngeal structures which is recorded on videotape or digital disk (correct)

Patient asked to swallow saliva as many times as possible for 30 seconds while deglutition is counted through palpation of the larynx

involves passing a fiberoptic laryngoscope through the nasal cavity into hypoharynx; can view larynx and surrounding structures (from a superior view);

What positions are patients in during the VFSS?

Seated position, occasional standing, video chair, booster seat for peds

During the oral phase, we can visualize poor labial closure/drooling and anterior loss of PO. What else can be visualized on VFSS?

Drooling/anterior loss Prolonged oral prep) Tongue pumping and lingual mvmt (Parkinson’s) Serial or piecemeal deglutition Oral stasis/residue Poor mastication Decreased tongue elevation to palate

During a fees, part of the pharyngeal phase is obliterated by pharyngeal walls and bolus during the swallow when the endoscopic light is blocked. This is known as the ______.

White-out Signup and view all the answers

Fees can be used even with excessive oral secretions to assess PT’s tolerance of oral secretions.

True Signup and view all the answers

VFSS is performed to assess the pathophysiology of swallow dysfunction to determine LT and St goals and plan for nourishment and hydration. Why else do we perform VFSS?

Aspiration is occurring Severity of swallow dysfunction Which PO consistencies, if any, are safe Which strategies will improve safety of PO intake Pathophysiology of swallow dysfunction re: LT and ST goals and plan for nourishment and hydration Signup and view all the answers

What planes are observed during the VFSS?

Lateral and A-P planes Signup and view all the answers

During the pharyngeal phase, we can visualize penetration/aspiration: when, why, how much, response. What else can we visualize?

Delayed initiation of swallow trigger; bolus head past angle b/n base of tongue and mandible Reduced hyoid elevation Reduced laryngeal elevation Reduced pharyngeal contraction, contractile wave Vallecular stasis, residue Deviant epiglottic function –penetration Pyriform sinus stasis, residue Reduced laryngeal closure; in A-P view, have pt. vocalize to observe VF adduction Poor C-P opening (timing and duration); greater opening required for thicker consistencies Reflux into pharynx Signup and view all the answers

FEES involves passing a flexible nasal-endoscope that is connected to a source and to view the procedure and passed through the nose into the hypopharynx. The _ tip of the endoscope determines which structures are being viewed.

Light Monitor Distal Signup and view all the answers

During FEES, we can assess pharyngeal/laryngeal sensitivity, all aspects of airway protection, and the pharyngeal and pre-esophageal phases of swallowing. What else can we assess/visualize?

assesses pharyngeal/laryngeal sensitivity assesses all aspects of airway protection assesses pharyngeal and pre-esophageal phases of swallow assesses premature spillage of material into pharynx prior to swallow assesses delayed or multiple pharyngeal swallows assesses laryngeal penetration without aspiration assesses tracheal aspiration assesses location and amount of residue after the swallow reflux Signup and view all the answers

For VFSS which plane should be viewed first? Which plane do we view when there are concerns about symmetry?

Lateral; AP Signup and view all the answers

During a VFSS, you can view the oral and pharyngeal phases, as well as view the cervical esophagus.

True Signup and view all the answers

When given the choice, SLPS should opt to perform FEES over VFSS because it is cheaper and more practical.

False Signup and view all the answers

You cannot view real-time penetration/aspiration or amount during FEES.

True Signup and view all the answers

We cannot attempt compensatory strategies during a FEES due to the presence of the endoscope.

False Signup and view all the answers

ndicate when penetration/aspiration (before, during and after) the swallow is likely to occur based on the following impairments: Poor bolus control and delayed trigger Reflux and reside Reduced laryngeal closure and airway protection

Before, after, during Signup and view all the answers

What are 2 contradictions for VFSS?

Have reduced level of alertness Extremely ill Behavioral factors: combative, or other behaviors that prevent a good study Machines are small - claustrophobic and obese Signup and view all the answers

Facilitates utilize a uniform approach when administering PO trials.

True Signup and view all the answers

How much should the VFs rise during VFSS when looking at laryngeal elevation?

1-2 cervical vertebrae Signup and view all the answers

FEES involves passing a fiberoptic laryngoscope through the nasal cavity into the hypopharynx. We can view the larynx and surrounding structures from a superior view. This requires the clinician to be an expert in identifying the anatomical structures from a ______ view.

“Birds eye” Signup and view all the answers

All stages of swallowing can be visualized during a FEES.

False Signup and view all the answers

FEES is ⅓ to ¼ less than the cost of modified barium swallow.

True Signup and view all the answers

Early diagnosis of dysphagia (within a few days of admission) can increase daily reimbursement for management of this condition.

True Signup and view all the answers

Provide 2 examples of disadvantages of VFSS

Radiation exposure Not all pts can participate or cooperate Limited window Not always representative of “real life” conditions Signup and view all the answers

Who is present during the VFSS?

SLP and Radiologist Signup and view all the answers

VFSS: Who provides the patient with the instructions? Who presents the PO trials? o interprets the VFSS?

SLP, SLP, SLP and Radiologist Signup and view all the answers

Provide 3 benefits of using FEES vs VFSS

Direct visualization of the pharynx and larynx. No exposure to radiation. No need for ingestion of contrast. Can be completed in the patient’s natural environment. Can assist with differential diagnosis of dysphagia (vs reduced vocal fold mobility, GERD, polyps, etc). Signup and view all the answers

When assessing the esophageal phase, it is okay for the SLP to write: “Zenker’s Diverticulum noted at the level of C5-C6

False Signup and view all the answers

Provide 3 possible contraindication for performing FEES

bleeding disorders/blood thinners (coumadin) fainting seizure disorder known sensitivity to local anesthesia movement disorders (hyperkinetic) nose trauma acute cardiac problems Signup and view all the answers

Provide 3 possible adverse reactions to FEES

Nosebleed fainting vasovagal response – mechanical stim to upper airway with an instrument; usually causes fainting but can cause dysrhythmia or bradycardia in pts with cardiac hx laryngospasm allergic reaction to topical anesthesia (not used by SLPs) infection sinusitis laryngitis minor laryngo-pulmonary trauma Signup and view all the answers

What is an indicator of poor saliva management during a FEES assessment?

Accumulation of secretions Signup and view all the answers

What is the purpose of assessing laryngeal closure during a FEES assessment?

To assess airway protection Signup and view all the answers

Why is it important to assess sensation during a FEES assessment?

To assess decline in sensation Signup and view all the answers

What is the purpose of using green or blue dyed material during a FEES assessment?

To assess penetration and aspiration Signup and view all the answers

What can happen to the lens during a FEES assessment?

It becomes coated with secretions or food/liquid Signup and view all the answers

What is the importance of positioning the scope to see the vocal folds and advancing bolus simultaneously during a FEES assessment?

To assess timing and amount of penetration/aspiration Signup and view all the answers

What is the primary purpose of instrumental evaluation, including FEES?

To describe the physiological components of the swallow Signup and view all the answers

What is the main limitation of FEES in terms of assessing swallowing phases?

Cannot assess the oral phase of swallowing Signup and view all the answers

What is the role of the distal tip of the endoscope in FEES?

Determines which structures are being viewed Signup and view all the answers

Why has ASHA endorsed the practice of FEES?

Because it is within the scope of practice of SLPs, provided they have attained competence through training and education Signup and view all the answers

What is the main advantage of FEES in terms of patient comfort?

It is a more comfortable and less invasive procedure compared to VFSS Signup and view all the answers

What is the purpose of the thumb lever in FEES administration?

To raise the distal tip of the endoscope up and down Signup and view all the answers

What is the primary reason FEES is not intended to replace the fiberoptic exam done by ENT?

To assess the integrity of the laryngeal and pharyngeal structures Signup and view all the answers

According to Langmore et al. (1991), what is the significance of the comparison between FEES and MBS?

There is a statistically significant agreement between FEES and MBS in identifying aspiration Signup and view all the answers

When is it more appropriate to use MBS instead of FEES?

When assessing oral phase impairments Signup and view all the answers

What is a unique requirement for clinicians performing FEES?

Expertise in identifying anatomical structures from a 'birds eye' view Signup and view all the answers

What is a common goal of both MBS and FEES?

To assess swallowing function Signup and view all the answers

In which situation would FEES be preferred over MBS?

When reassessing swallowing function Signup and view all the answers

What is the main advantage of using FEES over VFSS?

It is a more portable and practical assessment tool Signup and view all the answers

What is the purpose of using blue or green dye during a FEES examination?

To make the food and liquid more visible during the examination Signup and view all the answers

What is the term used to describe the obliteration of the pharyngeal phase during a FEES examination?

White-out Signup and view all the answers

What is the primary advantage of using FEES over VFSS in terms of cost?

FEES is less expensive than VFSS Signup and view all the answers

What is the primary purpose of using FEES in the assessment of swallowing function?

To assess the pharyngeal and laryngeal phases of swallowing Signup and view all the answers

What is the benefit of using FEES in patients with excessive oral secretions?

It can be used to assess the patient's tolerance of oral secretions Signup and view all the answers

What is the purpose of using topical anesthesia during a FEES examination?

To reduce the patient's discomfort during the examination Signup and view all the answers

What is the advantage of using FEES in terms of patient convenience?

It can be performed at the bedside in a variety of settings Signup and view all the answers

What is the primary disadvantage of using FEES in terms of visualization?

It cannot visualize the esophageal phase Signup and view all the answers

What is the benefit of using FEES in terms of patient education and biofeedback?

It allows patients to view their swallowing function in real-time Signup and view all the answers

What is the purpose of using barium with different consistencies in a VFSS?

To evaluate the patient's ability to swallow different textures and consistencies Signup and view all the answers

What is the advantage of using commercially available pre-thickened barium in a VFSS?

It eliminates the need for modifying the barium consistency Signup and view all the answers

What is the significance of understanding how the barium stimuli map to the different levels on the IDDSI Framework?

It is important for making appropriate recommendations upon completion of the study Signup and view all the answers

What is the role of the IDDSI Testing Methods in a VFSS?

To understand how the barium stimuli map to the different levels on the IDDSI Framework Signup and view all the answers

What is the disadvantage of VFSS in terms of radiation exposure?

It exposes the patient to radiation Signup and view all the answers

What is the primary purpose of performing a videofluoroscopy swallow study (VFSS)?

To assess the pathophysiology of swallow dysfunction and determine long-term and short-term goals Signup and view all the answers

What is the benefit of using VFSS in assessing swallowing function?

It allows for real-time visualization of the swallow mechanism Signup and view all the answers

Which of the following is a contraindication for VFSS?

Patients with a reduced level of alertness Signup and view all the answers

What is the purpose of mixing food with barium during a VFSS?

To visualize the swallow mechanism Signup and view all the answers

Which of the following can be viewed during a VFSS?

The oral and pharyngeal phases of swallow, as well as the cervical esophagus Signup and view all the answers

What is the primary goal of using VFSS in assessing swallowing function?

To develop a plan for nourishment and hydration Signup and view all the answers

What is the characteristic of oral-transit time in mild dysphagia?

Less than 5 seconds Signup and view all the answers

When is non-oral supplement to oral feeding recommended?

When patient has oral dysphagia and slows food intake, but no risk of aspiration Signup and view all the answers

What is the characteristic of oral residue in mild dysphagia?

Less than 1/4 of bolus in anterior portion of oral cavity Signup and view all the answers

What is the general rule for oral-pharyngeal transport?

Swallow does not exist if oral-pharyngeal transport is more than 15 seconds Signup and view all the answers

When is oral feeding recommended?

When patient has no pharyngeal impairment and responds well to techniques Signup and view all the answers

What is the characteristic of severe dysphagia?

Suspected risk for aspiration and oral-pharyngeal transport of more than 10-15 seconds Signup and view all the answers

When would you recommend NPO to a patient?

When the patient's symptoms indicate pharyngeal involvement with severe risk of aspiration Signup and view all the answers

What is a common misconception about G-tube feedings in patients with terminal illnesses?

G-tube feedings are helpful in patients with terminal illnesses Signup and view all the answers

What is a potential risk associated with tube feedings?

Aspiration Signup and view all the answers

What is the role of the speech-language pathologist in the assessment and treatment of medically fragile patients with swallowing difficulties?

To educate the patient and family about swallowing mechanisms and risks Signup and view all the answers

What is a consequence of tube feedings, according to research?

No change in activities of daily living Signup and view all the answers

What is a consideration that speech-language pathologists should take into account when making recommendations about tube feedings?

The patient's and family's concerns and expectations Signup and view all the answers

Can view every phase of the swallow.

MBS Signup and view all the answers

Instrumental Evaluation

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Questions and Answers

What is the definition of a VFSS?

What positions are patients in during the VFSS?

During the oral phase, we can visualize poor labial closure/drooling and anterior loss of PO. What else can be visualized on VFSS?

During a fees, part of the pharyngeal phase is obliterated by pharyngeal walls and bolus during the swallow when the endoscopic light is blocked. This is known as the ______.

Fees can be used even with excessive oral secretions to assess PT’s tolerance of oral secretions.

VFSS is performed to assess the pathophysiology of swallow dysfunction to determine LT and St goals and plan for nourishment and hydration. Why else do we perform VFSS?

What planes are observed during the VFSS?

During the pharyngeal phase, we can visualize penetration/aspiration: when, why, how much, response. What else can we visualize?

FEES involves passing a flexible nasal-endoscope that is connected to a ____________ source and ____________ to view the procedure and passed through the nose into the hypopharynx. The _____________ tip of the endoscope determines which structures are being viewed.

During FEES, we can assess pharyngeal/laryngeal sensitivity, all aspects of airway protection, and the pharyngeal and pre-esophageal phases of swallowing. What else can we assess/visualize?

For VFSS which plane should be viewed first? Which plane do we view when there are concerns about symmetry?

During a VFSS, you can view the oral and pharyngeal phases, as well as view the cervical esophagus.

When given the choice, SLPS should opt to perform FEES over VFSS because it is cheaper and more practical.

You cannot view real-time penetration/aspiration or amount during FEES.

We cannot attempt compensatory strategies during a FEES due to the presence of the endoscope.

ndicate when penetration/aspiration (before, during and after) the swallow is likely to occur based on the following impairments: Poor bolus control and delayed trigger Reflux and reside Reduced laryngeal closure and airway protection

What are 2 contradictions for VFSS?

Facilitates utilize a uniform approach when administering PO trials.

How much should the VFs rise during VFSS when looking at laryngeal elevation?

FEES involves passing a fiberoptic laryngoscope through the nasal cavity into the hypopharynx. We can view the larynx and surrounding structures from a superior view. This requires the clinician to be an expert in identifying the anatomical structures from a ______ view.

All stages of swallowing can be visualized during a FEES.

FEES is ⅓ to ¼ less than the cost of modified barium swallow.

Early diagnosis of dysphagia (within a few days of admission) can increase daily reimbursement for management of this condition.

Provide 2 examples of disadvantages of VFSS

Who is present during the VFSS?

VFSS: Who provides the patient with the instructions? Who presents the PO trials? o interprets the VFSS?

Provide 3 benefits of using FEES vs VFSS

When assessing the esophageal phase, it is okay for the SLP to write: “Zenker’s Diverticulum noted at the level of C5-C6

Provide 3 possible contraindication for performing FEES

Provide 3 possible adverse reactions to FEES

What is an indicator of poor saliva management during a FEES assessment?

What is the purpose of assessing laryngeal closure during a FEES assessment?

Why is it important to assess sensation during a FEES assessment?

What is the purpose of using green or blue dyed material during a FEES assessment?

What can happen to the lens during a FEES assessment?

What is the importance of positioning the scope to see the vocal folds and advancing bolus simultaneously during a FEES assessment?

What is the primary purpose of instrumental evaluation, including FEES?

What is the main limitation of FEES in terms of assessing swallowing phases?

What is the role of the distal tip of the endoscope in FEES?

Why has ASHA endorsed the practice of FEES?

What is the main advantage of FEES in terms of patient comfort?

What is the purpose of the thumb lever in FEES administration?

What is the primary reason FEES is not intended to replace the fiberoptic exam done by ENT?

According to Langmore et al. (1991), what is the significance of the comparison between FEES and MBS?

When is it more appropriate to use MBS instead of FEES?

What is a unique requirement for clinicians performing FEES?

What is a common goal of both MBS and FEES?

In which situation would FEES be preferred over MBS?

What is the main advantage of using FEES over VFSS?

What is the purpose of using blue or green dye during a FEES examination?

What is the term used to describe the obliteration of the pharyngeal phase during a FEES examination?

What is the primary advantage of using FEES over VFSS in terms of cost?

What is the primary purpose of using FEES in the assessment of swallowing function?

What is the benefit of using FEES in patients with excessive oral secretions?

What is the purpose of using topical anesthesia during a FEES examination?

What is the advantage of using FEES in terms of patient convenience?

What is the primary disadvantage of using FEES in terms of visualization?

What is the benefit of using FEES in terms of patient education and biofeedback?

What is the purpose of using barium with different consistencies in a VFSS?

What is the advantage of using commercially available pre-thickened barium in a VFSS?

What is the significance of understanding how the barium stimuli map to the different levels on the IDDSI Framework?

What is the role of the IDDSI Testing Methods in a VFSS?

What is the disadvantage of VFSS in terms of radiation exposure?

What is the primary purpose of performing a videofluoroscopy swallow study (VFSS)?

What is the benefit of using VFSS in assessing swallowing function?

Which of the following is a contraindication for VFSS?

What is the purpose of mixing food with barium during a VFSS?

Which of the following can be viewed during a VFSS?

What is the primary goal of using VFSS in assessing swallowing function?

What is the characteristic of oral-transit time in mild dysphagia?

When is non-oral supplement to oral feeding recommended?

What is the characteristic of oral residue in mild dysphagia?

What is the general rule for oral-pharyngeal transport?

When is oral feeding recommended?

What is the characteristic of severe dysphagia?

When would you recommend NPO to a patient?

FEES involves passing a flexible nasal-endoscope that is connected to a source and to view the procedure and passed through the nose into the hypopharynx. The _ tip of the endoscope determines which structures are being viewed.