Assessment and Diagnosis of Pediatric and Adult Dysphagia in Speech-Language Pathology

What is dysphagia?

Difficulty chewing or swallowing.

What does feeding refer to in pediatric patients?

It includes multiple aspects of food and liquid intake.

Why is nutritional status important in dysphagia assessment?

To ensure the patient can maintain nutrition and hydration.

What are the four phases of a normal swallow?

Oral preparatory phase, Oral transit phase, Pharyngeal phase, Esophageal phase.

What is the purpose of knowing what normal swallowing looks like?

To identify what is abnormal in swallowing.

What is included in a thorough dysphagia assessment?

Case intake, chart review, client/caregiver interview, medical histories, observation, and direct assessment.

What should be identified in a comprehensive assessment of adult dysphagia?

Client's neurological, medical, cognitive, and feeding status.

What tools can be used to assess dysphagia impact on functional status?

Eating Assessment Tool (EAT-10) or SWAL-QOL.

What orofacial structures should be noted during dysphagia assessment?

Behaviors or deficits affecting the ability to safely eat and drink.

What aspects of orofacial function should be assessed?

Weakness, reduced sensation, poor coordination of lips, tongue, jaw, and laryngeal musculature.

What is the significance of velopharyngeal function in dysphagia?

Abnormal function can affect swallowing safety.

What is the role of observation in dysphagia assessment?

To identify any visible difficulties during eating and drinking.

What types of histories are important in dysphagia assessment?

Medical, developmental, social, and occupational histories.

What is the first step in a comprehensive assessment of dysphagia?

A thorough case history.

What is the focus of the oral preparatory phase in swallowing?

Preparation of food in the mouth for swallowing.

What occurs during the oral transit phase?

Movement of the bolus from the mouth to the throat.

What happens during the pharyngeal phase of swallowing?

The bolus is propelled through the throat.

What is the esophageal phase of swallowing?

The bolus moves through the esophagus to the stomach.

What factors can affect a person's ability to eat and drink safely?

Weakness, reduced sensation, poor coordination, and abnormal muscle function.

How can dietary limitations impact dysphagia assessment?

They can influence the patient's feeding status and safety during eating.

What should you do if a client is not alert or has known dysphagia?

Do not present food or liquids.

How should food be presented if it is safe for a client with dysphagia?

Present small bites in order from easiest to manage to most difficult.

What are the phases where dysphagia may occur?

Oral preparatory phase, Oral transit phase, Pharyngeal phase, Esophageal phase.

What developmental milestones should be considered in pediatric dysphagia?

Oral motor development, Physical development, Sensory development.

What is the gestational period for physical development in feeding?

11 weeks to 40 weeks.

At what age do chewing and swallowing skills become adequate for oral feeding?

Around 11 weeks gestation.

What physical developments occur at birth related to feeding?

Hard palate, tongue, fatty tissue, larynx, pharynx, esophagus, epiglottis, nasopharynx/oropharynx, hyoid bone, trachea.

What oral motor skill is present at 1 month of age?

Suckle-swallow pattern; tongue may protrude.

What feeding behavior begins to develop at 1 month?

Pattern for hunger and satiety.

What significant physical development occurs at 2 months?

Head control significantly improved.

What oral motor skills are observed at 4-5 months?

Good coordination of suck-swallow-breathe patterns; sucking becomes less reflexive.

What feeding behavior is introduced at 4-5 months?

Spoon feeding may be introduced.

What happens to sucking pads at 5 months?

Sucking pads continue to diminish.

What oral motor skill is present at 6-7 months?

Munching pattern, rhythmic pattern, lip closure.

What feeding behavior is observed at 7 months?

Infant can hold bolus over molars; excitement or eagerness during feeding.

What physical development is noted at 8-9 months?

Infant can independently hold and control bottle.

What oral motor skill is present at 9 months?

Tongue sensitive enough, lower lip used as stabilizer.

What feeding behavior is observed at 10-11 months?

Infant may become impatient, may turn head in refusal.

What oral motor skills are developed by 12 months?

Control and precision of tongue; pocketing is minimal or absent.

What feeding behavior is typical for children aged 13-18 months?

Mealtimes are consistent; diet may include chopped table foods.

What significant oral motor skill is developed by 19-24 months?

Can bite through most foods; licks lips clean.

What physical development occurs by 3 years?

All 20 deciduous teeth are present; independent feeder.

What oral motor skills are developed by 4-5 years?

Coordination for chewing and swallowing continues to improve.

What is a red flag in clinical assessment of pediatric feeding?

Presence of multiple infantile reflexes affecting feeding/swallowing.

What is nonnutritive sucking (NNS)?

Nonnutritive sucking is normal and important; a prerequisite for nutritive sucking (NS).

What is the difference between nutritive sucking (NS) and nonnutritive sucking (NNS)?

NS is slower than NNS.

What are compensatory techniques in chewing and swallowing?

Techniques that modify posture, provide manual support, adaptive equipment, alter food, feeding environment, pace of feeding, and food placement.

What clinical significance do findings of oral-motor weakness indicate?

They may suggest structural abnormalities, abnormal muscle tone, or reduced movement of oral structures.

What is silent aspiration?

A condition where aspiration occurs without noticeable symptoms, making it difficult for clinicians to detect.

What does MBSS stand for?

Modified Barium Swallow Study.

What is the purpose of the MBSS?

To provide a motion x-ray of the swallow and determine if a client is aspirating or penetrating the airway.

What is videofluoroscopy?

An objective test that provides a motion x-ray of swallowing, often used to assess dysphagia.

What does FEES stand for?

Fiberoptic Endoscopic Examination of Swallowing.

What is the primary use of videoendoscopy in swallowing assessments?

To view oral and pharyngeal structures before and after swallowing.

What does a diagnostic statement regarding swallowing function indicate?

It describes the patient's swallowing function, noting if it is within functional limits or if dysphagia is suspected.

What should be included when describing the phases of swallowing?

Characteristics of the oral phase and pharyngeal phase should be described separately.

What is the importance of addressing aspiration risk in clinical assessments?

To identify and mitigate risks associated with aspiration and penetration during swallowing.

What are the criteria for passing the classwork assignment?

Accurate interpretation of data, appropriate diagnosis, strong reasoning, and clear integration of evidence.

What is the role of ASHA practice portal in swallowing assessments?

It serves as a reference source for guidelines and best practices in speech-language pathology.

What is the significance of the oral-motor examination (OME) in swallowing assessments?

It helps to evaluate the function and integrity of oral structures involved in swallowing.

What is the expected outcome of a well-organized clinical impression?

It should be concise, use professional terminology, and clearly convey the findings and recommendations.

What does 'within functional limits' mean in a diagnostic statement?

It indicates that the patient's overall swallowing function appears to be normal.

What are some common symptoms to look for when assessing for aspiration or penetration?

Coughing, choking, and wet vocal quality.

What is the significance of using adaptive equipment in swallowing therapy?

It can help facilitate safe swallowing and improve the patient's ability to eat and drink.

What is the role of clinical assessment in diagnosing dysphagia?

It provides subjective information that may need to be supplemented with objective testing.

What should be done if further testing into swallowing function is warranted?

Additional assessments should be conducted to evaluate the patient's swallowing capabilities.