[Dysphagia] Clinical exam and VFSS

[eripley at yahoo.com (Irene Campbell-Taylor)]

ASHA has two relevant position papers extracts follow:
  Clinical Indicators for Instrumental
  Assessment of Dysphagia
  C. Clinical/Bedside Dysphagia Examination  (hereafter referred to as the clinical examination).
  Index terms: Knowledge and skills, swallowing assessment,
  A swallowing evaluation typically begins with a
  clinical swallowing evaluation and incorporates an
  oral-mechanism examination with test boluses as indicated.
   
  IV. Purposes of the Clinical Examination
  and the Instrumental Examination
  There are specific indications for both the
  clinical and instrumental examination. For patients
  with signs and symptoms of oropharyngeal dysphagia,
  instrumental procedures can provide more
  sensitive and objective documentation of findings
  than the clinical examination. Information gleaned
  from these exams can be used to make appropriate
  referrals and to determine appropriate management
  and treatment of dysphagia
   
  A. The purposes of the clinical examination are to
  enable the speech-language pathologist to:
  ? Integrate information from the interview/
  case history, review of medical/clinical
  records, standardized protocols, observations
  from the physical examination, and
  collaboration with physicians and other
  caregivers.
   
  Knowledge and Skills Needed by
  Speech-Language Pathologists
  Performing Videofluoroscopic
  Swallowing Studies
   
  D. Instrumental Dysphagia Examination
  (hereafter referred to as the instrumental
  examination). As described in the Preferred
  Practice Patterns for the Profession of Speech-
  ? Observe and assess the integrity and function
  of the following structures of the upper
  airway and digestive tract: face, jaw, lips,
  oral mucosa, tongue, teeth, hard palate,
  soft palate during nonspeech, speech, and
  swallowing tasks.
  ? Identify the presence and observe the characteristics
  of a dysphagia based on clinical
  signs and symptoms. This may include identifying
  factors that may affect swallowing
  function such as bolus size, bolus consistency,
  fatigue during a meal, posture, positioning,
  and environmental conditions.
  ? Identify clinical signs and symptoms of
  esophageal dysphagia or gastroesophageal
  reflux in order to make an appropriate referral
  to another specialty.
  ? Determine the need for an instrumental
  evaluation following the clinical examination.
  ? Assess coordination and effectiveness of
  lingual, velopharyngeal, pharyngeal, and
  laryngeal movement during swallowing.
  ? Determine presence, cause, severity, and
  timing of aspiration by visualizing bolus
  control, flow and timing, and the response
  to bolus misdirection.
  ? Visualize the presence, location, and
  amount of secretions in the hypopharynx
  and larynx, the patient?s sensitivity to the
  secretions and the ability of spontaneous or
  facilitated efforts to clear the secretions.
  ? Screen esophageal anatomy and function
  for evidence of dysphagia.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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