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Flashcards in Class 8 - Exam 2 Deck (15)
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1
Q

Why a Clinical Evaluation?

___/___ Evaluation
VERSUS
(Just the) ____ Evaluation

  • Some long-term care facilities do not have an ….
  • Use as a_____ for instrumental tests
  • Use as an _____ measurement
  • McCullough, Wertz, & Rosenbek (2000) only____% reliable on clinical exams. Need to standardize the clinical exam.
A

Clinical/Bedside Evaluation
VERSUS
(Just the) Instrumental Evaluation

  • Some long-term care facilities do not have an MBS or FEES machine available.
  • Use as a screening for instrumental tests
  • Use as an outcome measurement
  • McCullough, Wertz, & Rosenbek (2000) only 50% reliable on clinical exams. Need to standardize the clinical exam.
2
Q

Langmore & Logemann Article

  • Discussion:
  • Pros and Cons of a bedside evaluation
  • Why does Logemann feel that you should always include a clinical exam?
  • Clinical questions to be answered
  • Percentage of silent aspiration missed
  • Langmore recommends ____, why?
A
  • Discussion:
  • Pros and Cons of a bedside evaluation
  • Why does Logemann feel that you should always include a clinical exam?
  • Clinical questions to be answered
  • Percentage of silent aspiration missed
  • Langmore recommends FEES, why?
3
Q

Logemann’s 5 Reasons to Pursue a Clinical Exam

1)
2)
3)
4)
5)

A

1) To define a potential cause of a swallowing disorder
2) To establish a working hypothesis
3) To establish a tentative treatment plan
4) To develop a potential list of questions that may require further study
5) To establish the readiness of the patient to cooperate with further testing

4
Q

Clinical Evaluation:3 Main Components of a Clinical Evaluation

  1. ) Medical History-
    - -___ Review
    - -____
  2. ) Physical inspection of swallow mechanism
    - -___ ___ Exam
    - -___ ___ Exam
  3. ) Observation of swallow with test swallows
    - -__ ____ test- The Source, Tohara, et al., DiPippo, Holas, & Reding (1992); Garon, Eagle, & Ormistrin (1995)
    - -Prediction of ____ with screening tests
    - -Various ___ attempted
A
  1. ) Medical History-
    - -Chart Review
    - -Questionnaire
  2. ) Physical inspection of swallow mechanism
    - -Cranial Nerve Exam
    - -Oral-Mech. Exam
  3. ) Observation of swallow with test swallows
    - -3-oz. water test- The Source, Tohara, et al., DiPippo, Holas, & Reding (1992); Garon, Eagle, & Ormistrin (1995)
    - -Prediction of Aspiration with screening tests
    - -Various consistencies attempted
5
Q

Dysphagia Questionnaire

  • Ask client to describe their …..
  • May not be able to …
  • ____ or responses may not fit objective findings
  • Groher & Crary (textbook) found this is easier when problems are _____ vs. milder dysphagic symptoms
A
  • Ask client to describe their problems and symptoms
  • May not be able to describe problems
  • Unreliable or responses may not fit objective findings
  • Groher & Crary (textbook) found this is easier when problems are severe vs. milder dysphagic symptoms
6
Q

Samples of Questionnaire

  • __ ___ ___ (1991) (in text Box 9-1)
  • ___ ___ ___ Test (DiPippo, 1994)
  • __ ___ ___ Test (Wallace, et al., 2000)–Designed specifically for ____ Disease
A
  • Baker, Fraser & Baker (1991) (in text Box 9-1)
  • Burke Dysphagia Screening Test (DiPippo, 1994)
  • Wallace Dysphagia Screening Test (Wallace, et al., 2000)–Designed specifically for Parkinson’s Disease
7
Q

General Categories of Interview/Questionnaire Findings

  • _____
  • ___ vs. ____
  • _____Reflux
  • ____ Habits
  • ____ History
  • Obstruction: ___ or ___ sensation
  • Moser, et al.= more likely to have ___ ___ disorders when reporting this.
  • Liquids vs. Solids: solid food dysphagia= esophageal disorders….liquids more likely to have ____ dysphagia
  • Choking on liquids and or solids= more ___ related causes….in no choking reported, more likely to have _____ disorders
  • GERD: may not associate GERD with dysphagia
  • Eating habits: avoiding certain foods, take longer to eat, avoid eating around others,
A
  • Obstruction
  • Liquids vs. Solids
  • Gastroesophogeal Reflux
  • Eating Habits
  • Medical History
  • Obstruction: globus or globus sensation
  • Moser, et al.= more likely to have esophageal motility disorders when reporting this.
  • Liquids vs. Solids: solid food dysphagia= esophageal disorders….liquids more likely to have oropharyngeal dysphagia
  • Choking on liquids and or solids= more pharyngeal-related causes….in no choking reported, more likely to have esophageal disorders
  • GERD: may not associate GERD with dysphagia
  • Eating habits: avoiding certain foods, take longer to eat, avoid eating around others,
8
Q

Physical Examination

~___ Tubes
~_____ Tubes
~____- Oxygen Saturation, Rate. Oxygen levels below ___% indicates at risk for swallowing impairments: Practice O2 sensor
~___ Status - May be unable to cooperate
~__ ___ Examination: Which ones? ____ assessment or screen
~___ Muscles - lips at rest and at work—upper vs. lower motor neuron damage
~Muscles of ____
~____ Muscles
~____ Cavity
~_____
~_____
~Tongue movements: look for ____, atrophy, deviation
~Oral cavity: lesions, thrush infection, saliva, dentition
~Oropharynx: velum at rest and at work, gag reflex (NOTE: presence or absence not indication that they have normal swallow or are at resk. Absence might suggest other problems if other findings are noted.
Pharynx: No clinical tests of pharyngeal function: listen for vocal fold function,

A

~Feeding Tubes
~Tracheostomy Tubes
~Respiration- Oxygen Saturation, Rate Oxygen levels below 90% indicates at risk for swallowing impairments: Practice O2 sensor
~Mental Status - May be unable to cooperate.
~Cranial Nerve Examination: Which ones? Sonies assessment or screen
~Facial Muscles - lips at rest and at work—upper vs. lower motor neuron damage
~Muscles of Mastication
~Tongue Muscles
~Oral Cavity
~Oropharynx
~Pharynx
~Tongue movements: look for fasciculations atrophy deviation
~Oral cavity: lesions, thrush infection, saliva, dentition
~Oropharynx: velum at rest and at work, gag reflex (NOTE: presence or absence not indication that they have normal swallow or are at resk. Absence might suggest other problems if other findings are noted.
Pharynx: No clinical tests of pharyngeal function: listen for vocal fold function,

9
Q

Pharyngeal Function- Clinical Evaluation

~\_\_ \_\_\_ \_\_\_ test
~\_\_ \_\_\_\_/ Laryngeal palpation test
~Cervical \_\_\_\_
-\_\_\_ audible sounds
-\_\_\_\_:
1. \_\_\_\_ Cardiology II (3M Corp.)
2. \_\_\_ - \_\_\_\_  Pediatric Size (H-P)
3. \_\_\_ surface vs. \_\_\_\_\_ Surface
A
~Vocal Fold function test
~Digital Manipulation/ Laryngeal palpation test
~Cervical Auscultation
-Three audible sounds
-Stethescopes:
1. Littman Cardiology II (3M Corp.)
2. Rappaport-Sprague  Pediatric Size (H-P)
3. Bell surface vs. Flat Surface
10
Q

Testing Aspiration Clinically- Is it Reliable? Is it Safe?

~Mann & Hankey (2001)

  • Stroke patients N=71)
  • Regression Analysis of 23 Clinical features
  • 6 variables predictive of aspiration:
    1.
    2.
    3.
    4.
    5.
    6.

~Leder & Espinoza (2002)

  • Stroke patients (N=49)
  • Clinical exam = underestimated those who ___ and overestimated those who did __ ___
A

~Mann & Hankey (2001)

  • Stroke patients N=71)
  • Regression Analysis of 23 Clinical features
  • 6 variables predictive of aspiration:
    1. Impaired pharyngeal response
    2. Male
    3. Disabling stroke
    4. Incomplete oral clearance
    5. Palatal weakness
    6. >70 years old

~Leder & Espinoza (2002)

  • Stroke patients (N=49)
  • Clinical exam = underestimated those
    1. who aspirate and overestimated those
    2. who did not aspirate
11
Q

Swallow Tests

~Tohara, et al. Article Review

  • Three measures recommend for an effective alternative to instrumental examination
    1.
    2.
    3.

~Groher & Crary:

  • Crushed ___ first
  • 5- 10 ml of ___ then 20-ml ____ of water
  • ___ versus ___, clinician presentation versus client presentation
  • Solids in sequence of ____

~Modified Evans Blue Dye Test- MEBD
-For individuals with ____
-Test bolus’ with ____
-Deep suctioning every __ minutes for __ __
-Poor ____
~MEBD: Thompson-Heney & Braddock, 5 patients, MEBD found no ____ but MBS/FEES found that all 5 aspirated.

A

~Tohara, et al. Article Review

  • Three measures recommend for an effective alternative to instrumental examination
    1. 3 oz. purified water
    2. 4 grams of pudding
    3. Plain X-ray of the pharynx

~Groher & Crary:

  • Crushed ice first
  • 5- 10 ml of water then 20-ml bolus of water
  • Cup versus straw, clinician presentation versus client presentation
  • Solids in sequence of difficulty

~Modified Evans Blue Dye Test- MEBD
-For individuals with tracheostomies
-Test bolus’ with blue dye
-Deep suctioning every 15 minutes for one hour
-Poor reliability
~MEBD: Thompson-Heney & Braddock, 5 patients, MEBD found no aspiration but MBS/FEES found that all 5 aspirated.

12
Q

Feeding Evaluation

~Consistencies: Simplest to most difficult

  • ___
  • Thickened liquids:
    1. ___ ___ (easiest to swallow)
    2. ___ thick
    3. ____ thick
  • Chopped/ground/diced
  • ___ consistencies
  • Regular solids: __ __ to ___
  • ___ liquids

~Tools

  • ___
  • ___
  • ___
A

~Consistencies: Simplest to most difficult

  • Purees
  • Thickened liquids:
    1. Pudding thick (easiest to swallow)
    2. Honey thick
    3. Nectar thick
  • Chopped/ground/diced
  • Mixed consistencies
  • Regular solids: mechanical soft to crumbly
  • Thin liquids

~Tools

  • Spoon
  • Cup
  • Straw
13
Q

Results:The Functional Oral Intake Scale

  1. _____
  2. ____ dependent with minimal attempts at food or liquid
  3. Dependent with consistent intake of __ or ___
  4. Total __ ___ of a__ ___
  5. Total __ __ with ___ ___ but requiring ___ ___ or compensations
  6. Total __ ___ with ___ ___ without __ ___ but with
    specific food limitations
  7. Total ….
A
  1. NPO
  2. Tube dependent with minimal attempts at food or liquid
  3. Dependent with consistent intake of liquid or food
  4. Total oral diet of a single consistency
  5. Total oral diet with multiple consistencies but requiring special preparation or compensations
  6. Total oral diet with multiple consistencies without special preparation but with
    specific food limitations
  7. Total oral diet with no restriction
14
Q

Non-standardized Forms

___ Template

The __ __ __

____ Evaluation

Site Specific Forms/Samples:
SMC
St. Francis

A

ASHA Template

The Source Clinical Evaluation

Logemann’s Evaluation

Site Specific Forms/Samples:
SMC
St. Francis

15
Q

Available Clinical Evaluation Instruments- Standardized

~Mann Assessment of Swallowing Function (MASA): First with Psychometric Integrity

  • Normed on 128 first-stroke patients
  • ___ scale utilized
  • ___ areas of assessment

~McGill Ingestive Skills Assessment (MISA)

  • ___ test, offers a predictive code
  • Clinically assesses in ____ environment
  • Examiner prepares various __ ___, patient attempts to eat them.
  • Designed for clinicians working with ___ adults in a __ ___ ___.
  • ___ areas of performance, 43 test items, 3-point scale for each.
A

~Mann Assessment of Swallowing Function (MASA): First with Psychometric Integrity

  • Normed on 128 first-stroke patients
  • Rating scale utilized
  • 24 areas of assessment

~McGill Ingestive Skills Assessment (MISA)

  • Standardized test, offers a predictive code
  • Clinically assesses in natural environment
  • Examiner prepares various food items, patient attempts to eat them.
  • Designed for clinicians working with older adults in a skilled nursing facility.
  • Five areas of performance, 43 test items, 3-point scale for each.