Dysphagia - week 5 quiz

VFSS and FEES

what does an instrumental assessment of swallowing look at?

* anatomical structures
* physiology of swallow mechanism
* screening of esophageal mobility
* assessment of adequacy of airway protection, efficiency and coordination of respiration/swallowing

When is an instrumental assessment warranted?

after a bedside if further investigation is needed

from a referral

if Pt. is already undergoing dysphagia therapy

When is an instrumental assessment **NOT** warranted?

* if Pt. is resistant /combative
* medically fragile
* may just not be ready!

T/F - a Pt. cannot have an instrumental done if they can’t follow commands

false! it can still be done

What is a videofluoroscopic swallow study (VFSS)?

a radiographic procedure that provides a direct, dynamic view of oral, pharyngeal, and upper esophageal function

AKA (modified barium swallow study)

What does a VFSS assess?

swallowing physiology and estimate the degree of swallowing impairment from observations made during the study

T/F - dysphagia can be evaluated without imaging

false! in order for it to be most accurate, imaging is necessary

A VFSS can help us determine if what has happened?

if aspiration has occurred. can determine the presence, timing, and amount of aspiration & assesses the anatomy and physiology of oropharyngeal swallow function

When is a VFSS indicated?

* when there is a need to observe oral prep, oral transit, pharyngeal and/or esophageal phases of swallowing
* diagnosed/suspected presence of abnormalities in anatomy
* an aversion to having an endoscope inserted
* persistent feeding refusal problem
* a need to determine treatment or management strategies to minimize the risk of aspiration and increase swallow efficiency w

What is a contraindication for a VFSS?

* Pt. cannot maintain adequate positioning
* allergy to barium
* Pt. doesn’t demonstrate a swallow response
* medically unstable
* unable to cooperate or participating in an instrumental examination

Limitations of a VFSS

* time constraints due to radiation exposure
* limited sample of swallow function may not be accurate representation of typical mealtime function
* positioning may not be optimal
* challenges in visualizing swallow due to poor contrast
* challenges in representing food typically eaten by a patient
* refusal of a bolus (barium not tolerated by Pt.)
* aversive behaviors that limit oral intake during an exam

What are some considerations for using the video imaging chair (VIC) in a VFSS?

* appropriate for off the floor
* weight limit
* radiation exposure

T/F - Barium is a naturally occurring element that makes things radio-opaque

true!

What does the SLP look at during a VFSS?

* evaluate anatomy for structural anomalies
* aspiration, post-swallow residue, suitability for specific interventions

T/F - stepping diagonally and forward can help the SLP reduce radiatoin

False! - stepping **backwards** and to the **side** will help reduce

they should wear a lead vest and collar, and protective goggles

T/F - VFSS is a pass/fail test

false

What is a FEES do?

Fiberoptic endoscopic evaluation of swallowing

* involves passing a flexible endoscope transnasally to obtain a superior view of the pharynx and larynx
* can be done in outpatient or bedside
* SLP, a physician, or both can do this test

What is a FEES looking at?

* structures and function of the upper aerodigestive tract
* visualization of the base of tongue, nasopharynx, hypopharynx, and larynx
* assessment of secretions and secretion management

what are specific contraindications for FEES?

* severe agitation or inability to cooperate with the examination
* severe movement disorder that interfere with safe administration
* severe bleeding disorders and/or recent severe epistaxis (nosebleed)
* history of recent trauma to the nasal cavity or surrounding tissue and structures secondary to surgery or injury
* bilateral obstruction of the nasal passages

what are some limitations of FEES?

inability to visualize the oral or esophageal phase of swallowing

limited ability to visualize the pharyngeal ohase

‘white out’ passage of the bolus and movement of the pharyngeal structures cannot be observed *during* the swallow b/c reflected light from tissue into the endoscope

discomfort / medical conditions of some patients

what is the structural and functional assessment done during a FEES?

* test structural and functional integrity of base of tongue, pharynx, velum, and larynx
* symmetry
* appearance of tissues
* lesions
* pooled secretions (can be an indicator of aspiration)
* food residue
* VP closure
* pharyngeal wall movement (falsetto)
* laryngeal adduction/abduction (phonation, inhale/sniff, forced breath hold, cough)

What are some advantages of a FEES?

* able to see more secretions/ secretion management
* reflux or esophageal phase
* avoids radiation
* can help with checking out vocal quality
* might be the better option for a medically complex patient

What are some advantages of a VFSS?

* able to see more with a barium swallow study
* can better help capture the patient’s normal posture when eating/drinking
* can see more anatomical features

What are some disadvantages of a FEES?

* more invasive / discomfort
* ‘white out’ passage
* limited ability to visualize pharyngeal phase

What are some disadvantages of a VFSS?

* issue of radiation
* Pt. may have an allergy to barium
* depends on the compliance of the Pt.
* time constraint due to radiation
* challenges in visualizing the swallow due to poor contrast
* pt’s size and / posture prevents adequate imaging or exceeds limit of positioning devices