07/08/2021
💥Check out what ASHA is including in their section regarding Adult Dysphagia! 👏🏽
💭Non-Instrumental Swallowing Assessment:
•The purpose of a non-instrumental swallowing assessment is to determine the presence (or absence) of signs and symptoms of dysphagia, with consideration for factors such as fatigue during a meal, posture, positioning, and environmental conditions.
•Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy ⭐️ REQUIRE INSTRUMENTAL ASSESSMENTS ⭐️ .
🔹In clinical settings, SLPs typically use one of two types of instrumental evaluation: the videofluoroscopic swallowing study (VFSS) or the fiber-optic endoscopic evaluation of swallowing (FEES).🔹
✍🏼A non-instrumental swallowing assessment may include:
•a medical chart review as well as an assessment or consideration of overall physical, social, behavioral, and cognitive/communicative status;
•the patient’s perception of function, severity, change in functional status, and quality of life;
•vocal quality at baseline;
•physiological status and vital signs, including heart rate, oxygen saturation, and respiratory rate as well as respiratory/swallowing pattern, which may vary across individuals and across the life span (Martin-Harris et al., 2005);
•secretion management skills, which might include frequency and adequacy of spontaneous saliva swallowing and the ability to swallow voluntarily;
•cranial nerve function;
•posture and positioning for feeding; and
status of oral care.
✍🏼During or following bolus delivery during per os (P.O.) trials including consistencies typically consumed by the patient in their natural environment, the SLP may assess:
•labial seal, anterior spillage and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence;
•behavioral signs and symptoms, such as throat clearing or coughing before/during/after the swallow, which may not always be indicators of pe*******on and/or aspiration;
•the impact of fatigue and/or respiratory function on swallowing;
•changes to physiological status/vital signs/voice quality; and
•the patient’s use of additional equipment, as appropriate (e.g., adaptive drinking cups).
✍🏼The clinical examination may inform recommendations for the management of dysphagia (Garand et al., 2020), including
•identifying clinical presentations of dysphagia;
•identifying potential risks and benefits initiating or modifying oral intake (e.g., risks of dehydration/malnutrition);
•determining the need for additional instrumental evaluation; and
•specifying diagnostic questions to be answered by instrumental evaluations.
The non-instrumental assessment of swallowing is ⭐️INSUFFICIENT⭐️ to infer specific information about laryngeal, pharyngeal, or upper esophageal anatomy and physiology required to develop effective treatment options and prevent consequences of dysphagia, such as dehydration, malnutrition, pneumonia, and death (Garand et al., 2020).
Dysphagia in adults is a swallowing problem involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.
